Wednesday, February 08, 2006

More on SMART and not-so-smart

The Washington Post (sub. req.) has a story about the SMART clinical trial and treatment interruption. I started a post here that was intended to be a screed about not citing original sources in news stories, but the more I looked at David Brown's story, the more I liked it. So I bagged my first post and now look a bit more closely at what Mr. Brown has to say, which includes:
  • outline of the study's structure and results;
  • a taste of the controversy surrounding the study's outcome; and
  • a better taste of the human concerns that prompted the study and follow in its wake.

In a nutshell: HIV treatment is a burden. There are too many pills. There are too many side effects. If the HIV doesn't kill ya, some of those side effects might. What if you interrupt treatment when CD4 counts are up and viral load is low? Oopsie. Not such a good idea. "Well, maybe it still is," some argue. "I don't care," says one happy fellow on drug holiday. "Why not be smart about SMART (get it?) and at least continue following those who were in the trial to see what happens long term 'cuz there might be, you know, some useful information there," says the advocacy community.

Brown says it better, of course, so do read his article.

That still doesn't meet my need for original sources, so I went on a hunt. Here's the NIH's latest press release on SMART. Here's NIH's Q&A about SMART. Here are minutes (scroll down or search the page for "SMART") from the AIDS Research Advisory Committee (ARAC) meeting on May 24, 2004, which suggest that there may have been trouble in the study early on. Webcasts/podcasts from the 13th annual CROI about SMART (scroll down to "Oral Abstracts: Antiretroviral Therapy II: New Insights and Treatment StrategiesFeb 7, 2006 10:00 AM "). That ought to keep us busy for a while.

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