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June 15, 1994

NIAID Recommendations for Treating HIV Infection

Author Affiliations

University of California—San Francisco

JAMA. 1994;271(23):1830. doi:10.1001/jama.1994.03510470034028

To the Editor.  —Recommendations by panel members at a recent conference sponsored by the National Institute of Allergy and Infectious Diseases (NIAID) to evaluate nucleoside analogue reverse transcriptase (RT) inhibitors in adults infected with the human immunodeficiency virus (HIV)1 are evidence of a growing trend to avoid RT inhibitors in asymptomatic individuals, particularly those with CD4+ cell counts higher than 0.50×109/L (500/μL). As an internist who has spent most of the past 6 years studying HIV from a virologist's point of view, I am concerned about this trend toward delayed treatment.First, nucleoside analogue RT inhibitors, such as zidovudine and didanosine, are static agents; they block HIV infection of new cells, but they do not kill cells that are already infected. Infected cells may continue to produce virus in the presence of RT inhibitors, though spread to new cells will be blocked. Relief from the RT inhibitor-selective

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