EARLY INITIATION OF ANTIRETROVIRAL THERAPY FOR INFECTION WITH HUMAN-IMMUNODEFICIENCY-VIRUS - CONSIDERATIONS IN 1996

In this AIDS Commentary, Dr. Nadler provides a rationale for early ini tiation of antiretroviral therapy in patients infected with human immu nodeficiency virus (HIV). Although no definitive clinical trials have been published that are relevant to the question of whether early trea tment will produce long-term benefit, many experienced investigators b elieve that early reduction in the level of viral replication will eff ectively prolong clinical latency of the infection and immunologic sta bility. A second question is that of the best combination of antiretro viral agents to be used for early treatment of HIV infection. A third issue is whether initial therapy should be continued until there is ev idence of virological, immunologic, or clinical progression of disease , or alternatively, whether a course of induction therapy with the mos t potent combination of agents should be followed by a treatment-free period or by less-aggressive maintenance therapy. These issues will co ntinue to be debated over the next several months. Dr. Nadler's review is timely, and it is a useful statement of the questions to be answer ed regarding treatment of early HIV infection.