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October 17, 2012

Treatment of Human Immunodeficiency Virus in Adults

Author Affiliations

Letters Section Editor: Jody W. Zylke, MD, Senior Editor.

Author Affiliations: London School of Hygiene and Tropical Medicine, London, England (Dr Yates; thomas.yates@lshtm.ac.uk). Dr Sonnabend is retired.

JAMA. 2012;308(15):1522-1523. doi:10.1001/jama.2012.12886

To the Editor: While the Strategic Timing of Antiretroviral Treatment (START)1 and other trials are being conducted, decisions on the initiation of antiretroviral treatment at higher CD4 cell counts must rest on complex observational evidence. Without randomization, individuals who initiate treatment early may be systematically different from those who initiate treatment later. We are concerned that publication of the recent update to the International Antiviral (formerly AIDS) Society–USA (IAS-USA) Panel's recommendations2 may slow recruitment to ongoing randomized controlled trials by suggesting there is no longer equipoise.