Letter from the editor.

DEAR READER

Not long after the introduction of highly active antiretroviral therapy (HAART) and the subsequent dramatic decreases in AIDS death rates, clinicians and patients alike became very interested in stopping HIV therapy. Once the notion of viral eradication under HAART was deemed impossible and the specter of viral drug resistance to potent HIV therapy was confirmed, our therapeutic paradigm for HAART changed. We realized that, depending on a patient's disease status, HIV drugs may be less like the lifelong, uninterrupted therapy we were first told about and more like a precious resource that must be used wisely to attain maximum benefit. Unfortunately, drug toxicities complicated the HIV therapy equation even more.

Consequently, a veritable explosion of treatment interruption research studies ensued. Reasons behind studying treatment interruptions have varied from "autovaccination" (the hypothesis that alternately starting and stopping HAART might enhance immune responses to HIV) to minimizing drug toxicities and side effects. Throughout the past half dozen or so years that such research has been conducted, we have learned a great deal about what works and what does not work when interrupting HAART. This issue of RITA! reviews the research conducted to date and some insights that such research has given us.

Although the abbreviation "STI" has been defined as "structured treatment interruption," "strategic treatment interruption," and even "supervised treatment interruption," it has now earned a permanent place in the lexicon of HIV/AIDS terminology. The question of when to stop or interrupt therapy is now considered by many to be as important as when to start therapy. Faced with increasingly limited resources and growing healthcare costs, national and local government could benefit from knowledge about when best to use HAART.

Perhaps what STI research underscores most is that HAART is imperfect. While HAART has clearly saved lives, it does not eradicate the virus from the human body and its use is associated with both short-term and long-term dangers. One might argue that, for some people, HAART could be considered a cure for AIDS (the most advanced stage of HIV disease). But now many HIV-infected people without AIDS diagnoses suffer from medication-related maladies or illnesses that, while not a direct result of HIV infection, are related to or complicated by HIV's effects on the immune system. We still need a cure for HIV.

Finally, you may have heard that one of The CFA's founders and a director for many years, Joel Martinez, died on November 12. Joel was a committed activist, a prolific writer, and a true inspiration for those who had the opportunity to work with him (see page 22). Joel was the Father of this publication and the great driving force behind HIV treatment advocacy in Houston. He was loved greatly and will be missed terribly. The CFA's legacy is to continue the work of HIV research/treatment information and advocacy (both locally and nationally), to which Joel dedicated his life. Joel's mantra "ThinkCure!" has never rung more loudly. As human beings, we must beat AIDS--and we must beat it soon.

Very truly yours,

The Center for AIDS: Hope & Remembrance Project Thomas Gegeny, MS, ELS Senior Editor