Researchers stress that the overall response rate of patients with persistent viremia in the quadruple-therapy group (participants who received nelfinavir, efavirenz and two nucleoside reverse-transcriptase inhibitors) points to "the importance of prescribing, whenever possible, at least two drugs of new classes for patients who have already received treatment...." In patients with previous exposure to all three classes of antiretroviral drugs, "regimens containing four or five drugs have achieved suppression of viral replication in only 15 percent of patients. This response rate is dismal and warrants a call to action for clinicians, scientists, and leaders in industry and government."

The promise of new agents is no guarantee of success, since the staggered release of new antiretroviral agents into clinical practice "often results in the addition of only one new drug at a time to a failing regimen, rather than the more effective simultaneous addition of at least two new drugs," the authors argue. Finally, there is the problem of the lack of any requirements for studying new antiretroviral agents in patients with previous exposure to all three classes of drugs. "The current regulatory requirements are not helping the most desperate patients. We need greater cooperation among academic, industry and regulatory agencies to improve the outlook for patients for whom effective treatment options are currently lacking," say the authors.

expensive drug treatments for AIDS patients is running out of money and will begin putting new applicants on a waiting list.