Which first combo is best?

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Some presentations at Barcelona tried to settle for once and for all which kind of antiretroviral combos were most likely to offer long-term success as first-line regimes.
One study, presented by A Bartlett of Dukes University in the US, compared using a non-nucleoside (efavirenz), a protease inhibitor (amprenavir, boosted by ritonavir), and a third nucleoside (d4T) when added to a 'backbone' of abacavir and 3TC.
After 11 months, 76 per cent of patients taking efavirenz had maintained viral loads under 50, compared with around 60 per cent of those on the protease inhibitors or the d4T. The comparative advantage was even more marked in patients who started with high viral loads. Rates of side effects in the three groups were similar, and pretty much what you'd expect - more diarrhoea in PI patients, psychological symptoms in those taking efavirenz, and neuropathy in those on d4T.

HIV 'remains incurable'

Hopes of eliminating HIV have been shown to be in vain, says Professor Robert Siciliano, of Johns Hopkins University in the USA.
HIV has been shown to take advantage of the memory of the body's immune system. It remains dormant in the cells known as 'resting memory CD4 cells'.
These cells act as reservoirs of viral DNA, some of which contains drug-resistance mutations. They serve as a permanent 'archive' of drug-resistant and non-resistant viruses.
A low level of viral replication continues despite combination therapy, Professor Siciliano explained, and the reservoir of memory CD4 cells, "guarantees lifetime persistence of the virus. It makes the disease intrinsically incurable with antiretroviral therapy alone."
Even using powerful 'Mega HAART' drug regimes early on in infection "simply won't work", added Siciliano. "This in itself is a powerful argument for effective HIV prevention campaigns," he said.

However, there is still positive news for people on antiretroviral therapy who achieve viral load levels below the present limit of detection, he said, because the drugs are capable of