Sceptism about data reported in AIDS PDF Print E-mail
Written by Alain Lafeuillade   
Thursday, 31 July 2014 17:20

Is AIDS now a Review without Stringent Evaluation of Accepted Papers?

ScepticA recent Report as a Research Letter in AIDS bring the question whether the journal NEEDS papers and is more turned to finishing an issue while publishing fragile scientific data...

We took the example of the Research Letter trying to convince us that PI monotherapy performs at least equally, even better, than HAART in lymphoid tissue (1). We got some surprize discovering that it wat not a "CONSORT" type trial. We think that the conclusions are flaved....


The study reports the comparison of 16 patients on ATRIPLA compared to 15 on Lopinavir/r or Prezista/r only.

No randomization was done.

Tonsils were considered as representative of the whole lymphoid tissue reservoirs.

Finally we compare patients on 2 types of regimens outside the widely accepted criteria of CONSORT ( Most of the results, despite the state of being closed to "statistical significance" (which statistics and what number of patients calculated for the trial for an hypothesis of what kind??).

An there we got, is the rapid conclusion that PI/r is even more effective thant NNRTI-EFV...

There is no discussion of the alternative interpretations, nor of the fact that all main objectives are NS. What is the number of calculated patients for each arm and on what hypothesis????


A question mark leading to a question mark. Is that the new standard for AIDS?

Discussion is open! Based on ref. 2!

1-Ref:VinuesaD, Parra-Ruiz J, Chueca N, et al. Protease inhibitor monothérapy is not associated with increased viral replication in lymph nodes. AIDS2014; 28: 1834-44

2-Fletcher CV, Staskus K, Wietgrefe SW, et al. Persistent HIV-1 replication is associated with lower antiretroviral drug concentrations in lymphatic tissues. Proc Natl Acad Sci U S A. 2014 Feb 11;111(6):2307-12. doi: 10.1073/pnas.1318249111. Epub 2014 Jan 27.



Key words: HIV DNA, HIV lymphoid tissue, HIV replication, HIV reservoirs
Last Updated on Thursday, 31 July 2014 18:13

jb 31.07.2014 (21:43:47)  
j Yes No  

Bigger question still, is when are they going to include depletion of MDSCs and immunomodulatio n to allow for strong and prolonged expression of Th1 attributes along with resolution of the arginigne depletion on T cells and and antiapoptotic agents to improve survival of CD4 and CD8 cells in addition to antiretroviral therapy as strategies to improve eradication of hiv from the host and also deal with the IL-6 issues? Seems to me we NEED to restore in these folks a reasonable immune system that is functional or at least not as impaired before any talk of cure.

Raj Kumar Subedi 01.08.2014 (06:42:52)  
Yes No  

Several methodological concerns.
Limited sample size, and no randomization. Only P-values are mentioned (what are the different statistical tests performed). Most of the data are presented in measures of central tendency and hence inadequate to assert what the investigators hypothesize.
Besides, in many of the results in this research, we see the differences (e.g. All patients except one had prompt reduction in plasma VL to <48 copies per milliliter....) but it is not clear whether the differences are because of chance, or because of some confounders. The paper lacks robust statistics to assert that the observed differences are statistically significant. Even though correlations are mentioned somewhere, multivariate analysis is needed with increased sample size and randomization. Otherwise, heading to interventions relying on skeptical findings could be not justifiable.
However, further researches can be done aimed at establishing the basis for potential cure for HIV-1.



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