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To the Editor.— The article by Dr Hogg and colleagues¹ offers an interesting population-based cohort study showing the clinical benefit of newer antiretroviral treatment strategies among human immunodeficiency virus (HIV)–infected individuals outside the setting of a controlled study. Nevertheless, a number of points need further clarification or evaluation before drawing important conclusions. The central message of the study is that antiretroviral therapy–naive patients initially taking regimens including stavudine or lamivudine (ERA-II) treatments had lower mortality and longer acquired immunodeficiency syndrome (AIDS)–free survival than those who initially received zidovudine-based, didanosine-based, or zalcitabine-based (ERA-I) therapies. In our opinion, it is hard to compare the clinical efficacy of these regimens in an observational study, because antiretroviral treatment strategies have changed considerably between the 2 eras and different potentially confounding variables have not been or have only partially been included in the analysis.

First, it is important to note that 51% of ERA-I subjects . . . [Full Text of this Article]

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Improved Survival Among HIV-Infected Individuals Following Initiation of Antiretroviral Therapy
Robert S. Hogg, Katherine V. Heath, Benita Yip, Kevin J. P. Craib, Michael V. O'Shaughnessy, Martin T. Schechter, and Julio S. G. Montaner
JAMA. 1998;279(6):450-454.
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