点击显示 收起
Bloomberg School of Public Health and Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland
Center for Urban Epidemiologic Studies, New York Academy of Medicine, New York
University of California, San Diego
Department of Medicine, Division of Infectious Diseases, Vanderbilt University School of Medicine, Nashville, Tennessee
All observational studies that have assessed the impact of highly active antiretroviral therapy (HAART) on the progression of HIV disease, not just our study, would benefit from longer follow-up. This would allow for a clearer ascertainment of both the short- and long-term benefits and risks of such therapy. Phillips and Lampe [1] hypothesize that the benefits of delaying HAART might not be seen until 10 years of follow-up. However, one could also hypothesize that the relatively small beneficial effect of HAART on the progression of disease among persons with CD4 cell counts >350 cells/mm3 (after a median of 24 years of follow-up) could be even more pronounced with longer follow-up. However, observational studies have several limitations that cannot be overcome simply by longer follow-up, many of which are mentioned by Phillips and Lampe [1]. Given the rapid changes in HAART over the past decadeincluding marked improvements in potency, tolerability, and dosing frequency, it is doubtful that we will ever have an observational cohort in which patients receive the same therapy for 10 years. New therapies are certain to emerge that will be adopted, and the details of the research questions will change over time.
Reference
1. Phillips A, Lampe F. When to start therapy. J Infect Dis 2005; 191:821 (in this issue). First citation in article