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Winter, Cécilea; Auperin, Isabelleb; Allaoui, Chakibc
aHopital André Grégoire, Montreuil, France
bHopital Saint-Joseph, Paris, France
cHopital Avicenne, Bobigny, France.
Received 8 May, 2007
Revised 27 July, 2007
Accepted 13 August, 2007
We were very surprised when we read the report by Martinez-Steele et al.  concerning an observational study conducted in Gambia between 1997 and 2003. The main purpose of their study was to compare the prognosis of HIV-1 and HIV-2 diseases. The authors state that there was no access to treatment in Gambia at the time of the study. Consequently, they described the natural history of the disease after the diagnosis of AIDS. However, at the time that their study began, highly-active antiretroviral therapy (HAART) was readily available in Europe, especially in the UK and the Netherlands. Therefore, we cannot understand how such an observational study could have been undertaken. Why did the authors observe their patients over 7 years without giving them HAART, the ‘life saving’ treatment? From a clinical point of view, offering a patient the best treatment available, after a diagnosis has been made, is a moral duty. From a scientific point of view, the CD4 cell count made at diagnosis at the time the patients were included in the study would have been sufficient. Everybody was aware that AIDS without treatment was a fatal disease.
The slogan of the international AIDS congress held in Geneva in August 1998, ‘one world one hope’, now sounds more ironic than ever. But such an assertion cannot be considered as a matter of fact (or of facts). The report by Martinez-Steele et al.  suggests that this assertion does not reflect reality. ‘There is only one world’: this is a principle. Without such a principle, medicine cannot exist.
© 2008 Lippincott Williams & Wilkins, Inc.
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