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Editor's Note
Sep 10, 2012

For Human Immunodeficiency Virus Disease, More Treatment Seems to Be BetterComment on “Immunovirologic Control 24 Months After Interruption of Antiretroviral Therapy Initiated Close to HIV Seroconversion”

Arch Intern Med. 2012;172(16):1256. doi:10.1001/archinternmed.2012.2776

It has been known since the 1980s that the progression of human immunodeficiency virus (HIV) was highly variable. In the absence of treatment, some persons succumbed quickly to the virus; others lived for more than 10 years without any sign of immunologic damage. Persons who successfully control the HIV without treatment have been actively studied with the hope of revealing clues that could be used to improve treatment for others, but so far, immunologic treatments for HIV/AIDS have been elusive.

Lodi and colleagues address whether short-term combination antiretroviral therapy at the time of HIV seroconversion would enable some patients to control the virus without treatment. If early treatment enabled control in some patients, it could decrease exposure to HIV medications and, thus, the adverse effects. Unfortunately, this cohort study demonstrates that few individuals are able to control the infection without treatment. Because HIV treatment has become more effective, with fewer adverse effects, and we have gained a better appreciation of the subtle harms that HIV causes, even when the patient seems healthy, the balance is increasingly moving toward initiation of treatment at seroconversion and maintenance of treatment thereafter. In the case of antiretroviral treatment for HIV, more treatment seems to be better.