HAART Denouement!

The authors, from the famous SF General Hospital, finally get to the heart of HAART with the following comments:

"After prolonged therapy, the absolute number of naive CD4 cells slowly increases. Whether these immunophenotypic changes reflect true immune reconstitution is controversial. CD4 cell function, as measured in vitro by lymphocyte proliferative responses to recall antigens, did not increase during the first year of antiretroviral therapy, suggesting that reconstitution of immune function is in fact delayed."

"Until these issues are clarified, clinicians should use the patient's CD4 cell count nadir as an indicator of immune status and not discontinue opportunistic infection prophylaxis or treatment in the face of a rising CD4 cell count."

"These observations underscore the uncertainties regarding the safety of long-term combination therapy in general and protease inhibitor therapy in particular."

Considering the drug company connections of the authors, the 5/6/98 JAMA article (the entire article below)is not exactly a ringing endorsement for HAART especially compared to their laudatory articles and comments circa Vancouver.

Dr. Volberding has consulted and been a speaker for Bristol-Myers Squibb and Glaxo Wellcome, has consulted for Agouron, and has been a speaker for Merck.

Dr. Deeks has been a speaker for and/or received grant support from Bristol-Myers Squibb, Merck, Agouron, Hoffmann-LaRoche, Abbott, and Glaxo Wellcome.