The natural history of antiretroviral therapy: continuum evaluation

Antiretroviral drugs have, as any medical therapy, their natural history. T hey are born by screening or designing of molecules with activity against H IV, their efficacy and safety is investigated by clinical trials, evaluated by regulatory bodies, used by clinical practice, and finally analyzed by q uality of care, economic, social and ethical studies. This flow of informat ion is dynamically accumulated, but it may stop if negative results are obt ained. The described knowledge pathway implies that specific methods are ne eded to answer different questions. At the same time, many decisions have t o be taken in order to keep the process flowing, including multiple agents, such as drug industries, government departments, clinicians, health care p roviders and health policy makers. This paper describes a comprehensive conceptual framework, including the mu ch less than knowledge much greater than on antiretroviral drugs, the much less than methodologies much greater than needed to generate them, and the underlying processes of much less than decision making much greater than. I t proposes the need for a continuum of assessment of these drugs.