In their interesting report, Nieuwkerk and colleagues1 confirm that adherence to highly active antiretroviral therapy (HAART) is limited in patients with human immunodeficiency virus type 1 (HIV-1) infection. The results of their study conducted in the Netherlands are not different from those reported from other countries2-5 and outline the well-known difficulties in adhering to a complex treatment that requires not only the accurate timing of doses, but also the observance of precise dietary instructions. However, is the patient's full adherence to HAART really vital to avoid disease progression? We believe that the time has come to reconsider the 2 major present "dogmas" in HIV-1 treatment, ie, the necessity of starting therapy using a HAART regimen in all infected subjects, independent of their clinical status, initial viremia, or CD4 cell count, and the importance of doing so to limit the risk of viral resistance due to incomplete suppression of viremia.6
Cainelli F, Vento S. Full Adherence to HAART: Is It Really Necessary? Arch Intern Med. 2002;162(8):944–945. doi:
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