Treatment Interruption: Erroneous Press Report
On July 20 an erroneous Reuters report on structured treatment interruption (STI -- also called structured intermittent therapy, or SIT), titled "Experts Caution Against an AIDS Therapy," appeared in several newspapers, including the Web site of The New York Times. The report said that STI does not work, and quoted Dr. Bruce D. Walker of Harvard as saying it had shown poor results. We were at the meeting reported -- a two-day clinical discussion organized by the International Association of Physicians in AIDS Care -- and in fact the information on STI was mostly positive, although the physicians agreed that it should be done in careful research studies and is not ready for widespread use until more is known.
Dr. Walker issued the following correction, which was widely distributed on email lists:
"I am quite upset to have been grossly misquoted in a recent report from Reuters regarding my views on STI. Augmentation of immune responses from STI has been clearly shown in treated acute HIV infection, and our own studies continue to show success in the majority of persons who have participated in a complicated STI trial. Although the durability of control and the exact clinical benefit in terms of overall outcome of infection has not been shown, the results show that at least transient immune control can be achieved. In contrast to the promising results in acute infection, similar immune boosting and control of viremia in chronically-infected individuals appear to be difficult to achieve. However, there may be benefit from reduced drug exposure in persons with chronic infection, and there are also other adjunctive measures that may confer benefit, such as therapeutic vaccines. At Massachusetts General Hospital we have a trial that is ongoing looking at therapeutic vaccination and STI in chronic infection, and others are soon to open. For now I recommend that persons not try STI on their own but that these approaches be supervised in a research setting to enhance safety and to ensure that we learn the most we can in the most expeditious fashion. We and others have clearly shown that the immune response to HIV can be boosted after a person becomes infected, and we have to believe that we can be smart enough to induce even better responses that will lead to persistent clinical benefit."
Another physician's name was misspelled in the article (making the erroneous report easy to find through computer searches -- look for "Steerer").
The reason for concern is that patients may change treatment decisions or drop out of clinical trials, based on wrong information.
What happened here is that this story was not written by Reuters Health, the unit which usually writes medical stories for the wire service, but by a reporter from another Reuters unit who had never covered an AIDS meeting before. And this event was hard to report because it was not intended for media (although not closed to the press either). IAPAC brought together some of the leading HIV physicians and clinical researchers in the country to discuss difficult issues in antiretroviral treatment, so that guidelines for physicians can be prepared. The two-day meeting itself was excellent, and we look forward to the guidelines, which should be published in a few weeks.
This incident illustrates that news reports on medical subjects too often include serious errors. Media stories -- in treatment newsletters as well as the general press -- can be used as leads for further investigation, but should never be the main reason for changing treatment decisions.
ISSN # 1052-4207
Copyright 2001 by John S. James. Permission granted for noncommercial reproduction, provided that our address and phone number are included if more than short quotations are used.
Back to the AIDS Treatment News July 27, 2001 contents page.