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Re: HAART and life span
May 22, 2001

Your answer to HAART and life span left me confused. "Since the advent of combination therapies the death rate has gone from 30/100 person years for those with advanced AIDS to around 5/100 person years. One would be tempted to say that the life expectancy has gone from 3 to around 20 years. This is not wholly accurate, for a variety or reasonsIndeed, the same analysis showed that the average lifespan of a combination therapy in the general population was only 15-18 months". Yikes!

Reading more carefully I see we talking about two different things here--the life expectancy for PWAs and the life expectancy of a particular combination therapy? A lot of people may miss that distinction and just think that antiretrovirals only extend life a year and a half.

By the way, has anyone ever told you that you look like the character Father Mukada on the HBO prison drama Oz?

Response from Dr. Young

Thanks for pointing out the ambiguity in my answer. The real point is that while we expect PWAs to live alot longer than in the past; current drug combinations need to be improved considerably- we need drug regimens that are better tolerated, have simplifed dosing and pill burden and durability.

The average duration of first HAART treatment should not be confused with the average extension of life expectancy. People discontinue their initial regimen for a variety or reasons, side effects, complexity , cost and virologic failure, to name a few. The overall quote of 18 months includes all reasons for treatment discontinuation, much in the way that an intent-to-treat analysis of a clinical trial reports. If we expect therapies to prolong life for a long time, we can safely expect that we will need multiple rounds of therapies. We now have substantial clinical and virological data that supports the sequential use of combination therapies, particularly those that contain protease inhibitors. What I had hoped to (insufficiently) to describe was the need to better understand how to best use our existing medications for the anticipated multiple rounds of therapy.

hope that this clarifies things. BY

(ps. I have not seen the HBO show, but will look for it at the next opportunity)



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