Margaret A.WinkerMD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Senior EditorIndividualAuthor
To the Editor.— The article by Dr Hogg
and colleagues1 offers an interesting population-based
cohort study showing the clinical benefit of newer antiretroviral treatment
strategies among human immunodeficiency virus (HIV)–infected individuals
outside the setting of a controlled study. Nevertheless, a number of points
need further clarification or evaluation before drawing important conclusions.
The central message of the study is that antiretroviral therapy–naive
patients initially taking regimens including stavudine or lamivudine (ERA-II)
treatments had lower mortality and longer acquired immunodeficiency syndrome
(AIDS)–free survival than those who initially received zidovudine-based,
didanosine-based, or zalcitabine-based (ERA-I) therapies. In our opinion,
it is hard to compare the clinical efficacy of these regimens in an observational
study, because antiretroviral treatment strategies have changed considerably
between the 2 eras and different potentially confounding variables have not
been or have only partially been included in the analysis.
De Luca A, Antinori A, Ortona L. Antiretroviral Therapy and Improving AIDS Survival. JAMA. 1998;279(23):1874–1875. doi:10-1001/pubs.JAMA-ISSN-0098-7484-279-23-jbk0617
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