The communication by Donald Forsdyke in the Jan. 24 issue of The Scientist1 was quite interesting. However, I disagree that resistance is the primary factor in HAART [highly active antiretroviral therapy] failure. Obviously, if it were, there would be no long-term efficacies for HAART in HIV, and there are. For example, Garcia et al. reported that discontinuation of patients' HAART after one year of successful treatment is followed by a rapid rebound of viral load; this rapidly returns to undetectable levels following reintroduction of the same treatment.2

Similarly, Finzi et al. reported that after HAART treatment for up to 30 months, replication-competent HIV was routinely recovered from resting CD4+ T lymphocytes, and the recovered virus generally did not show mutations associated with resistance to the relevant antiretroviral drug.3 Thus, it would seem that the failure of HAART to cure AIDS is not primarily a resistance problem,...

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