Early initiation of antiretroviral therapy for infection with human immunodeficiency virus: considerations in 1996

In this AIDS Commentary, Dr. Nadler provides a rationale for early initiation of antiretroviral therapy in patients infected with human immunodeficiency virus (HIV). Although no definitive clinical trials have been published that are relevant to the question of whether early treatment will produce long-term benefit, many experienced investigators believe that early reduction in the level of viral replication will effectively prolong clinical latency of the infection and immunologic stability. A second question is that of the best combination of antiretroviral agents to be used for early treatment of HIV infection. A third issue is whether initial therapy should be continued until there is evidence of virological, immunologic, or clinical progression of disease, or alternatively, whether a course of induction therapy with the most potent combination of agents should be followed by a treatment-free period or by less-aggressive maintenance therapy. These issue will continue to be debated over the next several months. Dr. Nadler's review is timely, and it is a useful statement of the questions to be answered regarding treatment of early HIV infection.