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October 25, 2000

Viral Load in Treatment With Antiretroviral Therapy and Interleukin 2—Reply

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Executive Deputy EditorIndividualAuthor

JAMA. 2000;284(16):2055-2056. doi:10.1001/jama.284.16.2053

In Reply: We agree with Dr Aboulker that potential biases introduced by differences in treatment adherence can confound the statistical analysis of any study. However, short of serial measurements of plasma antiretroviral drug levels, there are no well-accepted surrogates for adherence beyond patient self-reporting as determined through interval history taking. In our study, we had no evidence that ART adherence was superior in the IL-2 plus ART treatment arm. Indeed, one could postulate that patients in the IL-2 plus ART arm, by virtue of their marked CD4 cell count increase, might have had less motivation to adhere to their medication schedule than the control group. Table 2 in our article presents the viral load outcomes when the analysis is restricted to just those patients reported to be taking protease inhibitors during the 90 days prior to the final branched DNA (bDNA) determination.

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