Efavirenz in HIV Infection

To the Editor: Staszewski et al. (Dec. 16 issue) 1 report that “the combination of efavirenz, zidovudine, and lamivudine has greater antiviral activity . . . than the combination of indinavir, zidovudine, and lamivudine.” However, their conclusions may have been overstated. Open-label studies such as theirs are less expensive, are easier to perform, and require fewer pills than randomized studies, but the design may not be adequate to compare two very different treatments, in terms of both the number of pills and the dosage (four pills of indinavir taken three times daily without food and three pills of efavirenz taken once . . .