If you can bear to hear the truth you've spoken Twisted by knaves to make a trap for fools 9 July 2003
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Carl Williams,
Lay person
TQ11 0lQ

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Re: If you can bear to hear the truth you've spoken Twisted by knaves to make a trap for fools

Peter Flegg’s assurance that the experience of physicians (presumably those who attend drug company sponsored HIV conferences/meetings), through a risk-benefit analysis, ensures that individuals diagnosed HIV + can expect a 1 in 3 chance of avoiding clinical and laboratory adverse effects at any one time on HAART, will no doubt be of great comfort to those newly diagnosed.  

However I am not sure that the readers of the BMJ debate will view his comment: “Any fool can sit at a computer keyboard and pull out hundreds of references to toxicity associated with HIV therapies” particularly supportive of his notion that HIV therapy is clearly beneficial.  

Regardless of whether or not I am a fool, Peter Flegg’s assertion that: “the balance of the equation is clearly and unambiguously weighted in favour of therapy”, still remains un-supported by clinical research - as I pointed out in my original response to his ‘drowning’ analogy.  It is the absence of any supportive research that individuals are better off taking therapy than not, rather than the abundance of negative data associated with those who are taking therapy, that I have drawn attention to.  

I question the relevance of Peter Flegg’s remarks: “It is facts like these which contribute to the broad consensus and acceptance that HIV therapy is clearly beneficial”. In 1996 the consensus advocated: “hit hard hit early” and ever since that time the consensus has been shifting in favour of delaying the initiation of therapy for as long as possible, - hardly an indication that the therapy itself is responsible for the benefits Peter Flegg describes.  

During the era of AZT Monotherapy, the median time from HIV diagnosis to initiation of treatment was 2.1 years.  During the era of double therapy, this had been extended to 6 years and by the time triple, or combination therapy began, the median time had stretched to 7.7 years.  

I don’t deny that it is entirely possible that currently available therapies are considerably less toxic than previous regimens.  However, as the few examples that I cited were from the past 2 years, one can only draw the conclusion that previous regimens must have had horrendous problems (a point that Chris Tyler has drawn attention to).  Regardless of the relative toxicity between HAART and previous therapies, it remains true that until such time as proper randomised, double- blinded placebo, controlled studies show that there is a benefit from receiving HAART as opposed to no therapy at all, it remains, as Peter Flegg has pointed out, merely “speculation”.  

Carl Williams

Competing interests:   None declared