In Reply: As noted by Dr Clay and
associates, the results of the INCAS trial have been used to establish
guidelines. We agree that it is unfortunate when guidelines must be
based on preliminary reports, but we also agree with the experts and
applaud their efforts to use the most current information available.
The end-of-trial results for the INCAS trial were reported in several
different ways, which may have led to some confusion. First, simple
descriptive presentation focused on the final visit at 52 weeks and
noted that 51% of patients receiving the combination of nevirapine,
zidovudine, and didanosine had undetectable levels of HIV. Second, to
use a more stringent standard in defining durable viral suppression, we
also reported patients with undetectable viral load at all available
visits between 40 and 52 weeks. The majority of patients had 3 or 4
observations in the interval, and several patients "failed" based
on a single value, not necessarily their week 52 value, with detectable
virus. In short, there are no contradictions in the information
reported.