One of the strong arguments for starting maximum treatment immediately is that the immune damage is irreversible. I am not sure about that. And for those with CD4 counts over 150, it seems that immune damage is quite reversible. So it is an open debate about reversibility. We have to learn much more about this.
Most people agree there are better, simpler drugs on the horizon.
There needs to be more critical discussion of what is the best time to use a complex, highly active regimen. I am taking care of about 300 patients, and we have projected for 1997 that we may have about eight patients who will have died this year. For people who came into 1997 and did not have a near-terminal condition, and were on antiretroviral therapy, I have only had one new AIDS opportunistic infection that we have diagnosed in 1997 to date. This amazing improvement leaves me puzzled about how much of the prophylaxis to continue. The people I am now seeing in the hospital are mostly new patients.