WILL WE EVER KNOW WHEN TO TREAT HIV-INFECTION

Confidence in the efficacy of using antiretroviral drugs to treat HIV infection has grown in the past year as a result of the prolonged surv ival of those randomly allocated to receive an additional drug in comp arative controlled trials, HIV remains, however, the only serious infe ctious disease for which antimicrobial treatment is deliberately delay ed. This is because infected subjects can often be symptomless for mor e than a decade in tile absence of any treatment, and results from tri als with the nucleoside analogue reverse transcriptase inhibitor zidov udine have failed to show any evidence for extended survival in those beginning treatment early compared with those who deferred treatment. The new confidence in currently available treatments, and in the prosp ects for new ones, inevitably leads to renewed questioning of the curr ent strategy of waiting for signs of immune deficiency before electing to intervene. A new randomised controlled trial comparing strategies of early and deferred treatment is required to assess whether the time has come for intervention immediately after HIV has been diagnosed.