Letter from the Editor

Dear Reader,

June 2001 marks the 20th anniversary of AIDS in the United States. Although HIV apparently has had a long evolutionary journey, mainly through other primates, it now has the distinction of being a leading cause of human death worldwide. Almost half a million Americans have died of AIDS complications, while between 700,000 and 900,000 are believed to be HIV-infected. The number of deaths and infections worldwide are many millions more. The question now, as always, is When will we find a cure or a vaccine?

In the meantime, we do what we can to keep people with HIV alive. Antiretroviral drugs have bought time for those lucky enough to live in developed countries. However, these medications, with their myriad side effects and drug interactions, may not yield their maximum benefit because we lack essential information on how to use them most effectively. Treatment guidelines for the use of antiretroviral drugs have vacillated from hitting hard and hitting early to waiting to treat. The guidelines have been based on observation and expert opinion, but not clinical trial data. In just 5 years, the recommendations have changed dramatically. How much more change is in store?

The recently funded Strategies for the Management of Anti-Retroviral Therapy (SMART) study, designed by the Community Programs for Clinical Research on AIDS (CPCRA), proposes to answer important questions about the best use of antiretroviral therapy. These questions include whether to use therapy aggressively or conservatively, whether to monitor patients primarily using viral load or CD4 T cell count, etc. The long-term follow-up of the 6000 patients enrolled will finally yield some answers about how best to treat HIV disease. Without such an effort, our guesses about how to treat HIV are based on much smaller, short-term studies that tell us nothing about the effects of these treatments on clinical endpoint. Furthermore, SMART will offer long-term prospective data on other issues like health care utilization, metabolic complications, and therapy adherence.

The medical community must reach a consensus on a standard of care for HIV disease based on clinical evidence. Investment in technologies like HIV resistance testing continues, despite the paucity of evidence to prove their clinical efficacy. The manufacturers of experimental therapeutic technologies are eager to find their niche in the milieu of HIV therapies. For example, a California biotechnology firm recently issued a press release about a system to filter HIV from the blood, even though most HIV is in body tissues. The release stated, "…it is conceivable that this process could limit the spread of HIV throughout the body, especially if it is used along with the current repertoire of HIV inhibitors." A snake-oil approach to HIV therapy distracts medical progress. We need clinical endpoint studies like SMART to sort the wheat from the chaff.

This issue of RITA! covers the SMART Study. The smaller physical dimensions of the issue reflect our intention for it to be used as a convenient reference about the study. Future issues of RITA! will continue to be organized thematically. The new publication schedule calls for issues in the spring and fall of each year. Thanks for your readership and support.

Very truly yours,

The Center for AIDS: Hope & Remembrance Project

Thomas Gegeny, M.S., E.L.S.
Editor

Back to the RITA! Spring 2001 contents page.