In addition to this study's 'top-line' finding -- that d4T/3TC/indinavir is as effective as AZT/3TC/indinavir at reducing viral load -- the data presented in this study are significant for two further reasons. First, Dr. Hogg and colleagues have provided further evidence that there is not necessarily any sort of 'magical' synergy between AZT and 3TC. d4T and 3TC can be as potent (and for some patients less toxic) an RTI combination as the well-known AZT/3TC combo. A great deal of data indicating that d4T/3TC is a potent combination when used with a protease inhibitor (in this instance, indinavir) was first presented in Chicago in February at the Retrovirus Conference, and this study confirms the data shown there.

Secondly, this study enrolled 191 patients, all recruited from a Vancouver drug treatment program. Dr. Hogg and his colleagues are to be congratulated for showing that quality clinical trials can be conducted in this population, which is written off by many researchers as too difficult to work with. The team from Vancouver concluded by pointing out the need for prospectively designed trials that are inclusive of all patients with HIV.