HAART Failure

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,...