[Evaluation of the efficacy of anti-retroviral treatment. Publication of clinical trials].
BACKGROUND
Although it is true that the practice of medicine is a combination of both science and art, clinical decisions regarding antiretroviral treatment should be based on scientifically validated recommendations by data obtained from patients in randomized and controlled clinical trials. Moreover, the information that is currently available regarding antiretroviral treatment is enormous and in some cases contradictory. Therefore, it appears reasonable to take into account that, without forgetting recent results from studies presented at congresses, symposia, and other meetings, the most important data when determining recommendations on the treatment of patients infected by HIV should be those published in renowned journals, which are submitted for a strict "peer review" of the publication. Nevertheless, it is also true that this review process may take months, invalidating the results from a "current news" point of view, especially in an area with a rapid turnover of knowledge as is antiretroviral treatment.


METHODS
Systematic review of the literature published evaluating antiretroviral treatment.


RESULTS
Over the last 10 years, we have witnessed how mono and bitherapies against the HIV have gradually been neglected, although short-term results had been obtained, favoring triple combinations which usually include two nucleoside analogues and a potent protease inhibitor. In general, this therapeutic practice accounts for the impressive decrease in morbi-mortality in patients infected by HIV which has been observed in the Western world. Globally, the most notable results published to this date in terms of antiretroviral efficacy and good tolerability compared to other highly effective alternatives, are possibly those related with indinavir in association with AZT plus 3TC. Despite this fact, on occasions the duration of these long term treatments becomes complicated due to the appearance of adverse effects, although a substitution of same by less potent alternatives is not possible without affecting antiviral efficacy. Finally, it should be noted that all these exceptionally good results are obtained with the treatment with protease inhibitors and triple therapy have set the pace for a substantial immunological improvement allowing for the possibility of discontinuing prophylaxis therapy against different pathogens such as, e.g. primary prophylaxis against P. carinii.
Mallolas
J
J
Servicio de Infecciones, Hospital Clínic, Barcelona.
D017088:AIDS-Related Opportunistic Infections / Q000517:prevention & control; D000163:Acquired Immunodeficiency Syndrome / Q000517:prevention & control; D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D019317:Evidence-Based Medicine; D015658:HIV Infections / Q000188:drug therapy*; D017320:HIV Protease Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D007255:Information Services; D016032:Randomized Controlled Trials as Topic; D012107:Research Design; D018894:Reverse Transcriptase Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D016896:Treatment Outcome; D015215:Zidovudine / Q000627:therapeutic use
D019380:Anti-HIV Agents; D017320:HIV Protease Inhibitors; D018894:Reverse Transcriptase Inhibitors; D015215:Zidovudine