HIV Digest	HIV Digest Archive

Keith Henry, M.D., a well-known AIDS physician in St. Paul, Minnesota, has called for a "cautious, patient-focused" approach to HIV treatment, in an article published in Annals of Internal Medicine. His article, and an accompanying editorial offer well-informed, balanced discussions of both the advantages and disadvantages of early, aggressive treatment, and the need to reconsider the hit-hard-hit-early philosophy, now that it is clear that eradication is unlikely with current interventions, and that decades of treatment might be necessary.

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For example, Dr. Henry describes the enormous benefit of modern antiretrovirals: "Deaths in our HIV population decreased 85 percent in a one-year period" when protease inhibitor based therapy was introduced. But he also notes that hope for eradication, "perhaps more than any other assumption... powered enthusiasm for immediately beginning treatment." With eradication not currently possible, he urges a new evaluation of risks and benefits of aggressive vs. conservative antiretroviral treatment.

"Early, aggressive therapy often prematurely exposes patients to risks for medication-related side effects and resistance. A more cautious, patient-focused, long-term approach to therapy would help foster studies of alternative strategies, such as delayed initiation of therapy, protease-sparing therapy, class-sparing therapy, planned drug interruptions, switches in therapy, and immune-based therapy. It is time for clinicians to rethink their approach to the treatment of HIV infection."

The article, with a link to the accompanying editorial, is available on-line to anyone (you do not need to subscribe to the journal) at: www.acponline.org./journals/annals/15feb00/henry.htm

Editor's Note: from AIDS Treatment News