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To the Editor: The report of the 2008 recommendations of the International AIDS Society–USA Panel by Dr Hammer and colleagues¹ provides current standards for the complex decision-making around antiretroviral treatment for AIDS. The article discussed when to start treatment in special populations, including persons with or at risk of specific opportunistic diseases and coinfections (hepatitis B and hepatitis C virus), patients with human immunodeficiency virus (HIV)–associated nephropathy, and pregnant women.

However, the article did not consider initiating treatment in relation to HIV-associated neurocognitive disorders, including dementia. I would suggest that future recommendations consider the potential role of central nervous system (CNS) sanctuary for HIV replication.^2-4

Financial Disclosures: None reported.

Jorge L. Zirulnik, MD
jorgezirulnik@yahoo.com
HIV/AIDS Unit
JA Fernandez Hospital
Buenos Aires, Argentina

1. Hammer SM, Eron JJ Jr, Reiss P; et al. Antiretroviral treatment of adult HIV infection: 2008 recommendations of the International AIDS Society–USA Panel. JAMA. 2008;300(5):555-570. FREE FULL TEXT 2. Antinori A, Cingolari A, Giancola ML, Forbici F, De Luca A, Perno CF. Clinical implications of HIV-1 drug resistance in the neurological compartment. Scand J Infect Dis Suppl. 2003;35(suppl 106):41-44. PUBMED 3. Smit TK, Brew BJ, Tourtellotte W, Morgello S, Gelman BB, Saksena NK. Independent evolution of human immunodeficiency virus (HIV) drug resistance mutations in diverse areas of the brain in HIV-infected patients, with and without dementia, on antiretroviral treatment. J Virol. 2004;78(18):10133-10148. FREE FULL TEXT 4. Price RW, Spudich S. Antiretroviral therapy and central nervus system HIV type 1 infection. J Infect Dis. 2008;197(suppl 3):S294-S306. PUBMED

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2008;300(21):2482.

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Antiretroviral Treatment of Adult HIV Infection: 2008 Recommendations of the International AIDS Society–USA Panel
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