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June 15, 1994

NIAID Recommendations for Treating HIV Infection-Reply

Author Affiliations

University of California—San Francisco

JAMA. 1994;271(23):1830. doi:10.1001/jama.1994.03510470034029

In Reply.  —I appreciate Dr Weiss' comments regarding the NIAID consensus panel's published recommendations dealing with antiretroviral therapy. Acquired immunodeficiency syndrome research is clearly in a period in which understanding of how the virus replicates and causes disease has not been translated effectively to the bedside. Treating this viral infection early certainly makes intuitive sense, especially since active replication occurs in the lymph nodes1 (even though clinically silent) and nucleoside resistance develops more rapidly in later stages of the disease,2 but data derived from clinical trials to date just do not show a significant survival benefit.3When to treat HIV infection and with which agent(s) is obviously a difficult clinical decision. However, the recent report by Lenderking et al4 certainly underscores the potential downside with regard to quality of life when taking zidovudine. That is why the NIAID convened a group of thoughtful clinicians and statisticians

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