Here is an important paper because it is an admission by the AIDS
mainstream that there is a very serious disconnect between the current
practice of using AIDS surrogate markers (CD4 and viral load) as
indicators of therapeutic benefit of the anti-HIV drugs. At the bottom
is a revealing excerpt.

Dave
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From:

Olsen, CH et al, Risk of AIDS and death at given HIV-RNA and CD4 cell
counts, in relation to specific antiretroviral drugs in the regimen
AIDS 2005, 19:319-330

complete pdf is 260 kb. I will send it on request.

Extract:

However, our results suggest that for a given CD4 cell count, HIV-RNA
and time from start of the drug (plus the other factors that we
adjusted for in our model) the risk of AIDS or death is the same,
regardless of the specific antiretroviral drug being used. It is
important to note that these results do not suggest that the regimens
assessed have equal clinical efficacy. Several published randomized
clinical trials have shown that different regimens have different
capacities to decrease the HIV-RNA and raise the CD4 cell count and
this will lead to a difference in clinical efficacy for different drug
regimens.

Complete reliance on the ability of surrogate endpoints to evaluate
treatment effect has led to adverse clinical outcome in other disease
areas; one example being antiarrhythmia drugs [42]. Therefore it is
imperative to revisit and validate historical assumptions on a regular
basis, especially in the case of new drug regimens [1].

To be an ideal surrogate, two basic conditions should be satisfied,
namely that the surrogate marker is a correlate of the clinical outcome
being the only causal pathway of the disease process, and that the
intervention's entire effect on the clinical outcome is mediated
through its effect on the surrogate [18,43]. The use of surrogate
markers such as

...

... However, the above-mentioned references suggest that also in the
field of HIV, it is necessary to validate surrogate markers against
effect markers regularly to evaluate the true treatment effect of drugs
and the predictive ability of surrogate markers on clinical
progression. The relevance of these type of analyses is evident,
knowing that complete reliance have been made on the virologic and
immunologic markers to measure treatment effect of drugs released after
1997, even though the relative proportion of non-AIDS-related death has
increased during the period of combination and highly active
antiretroviral therapy, and treatment effects and regimens have changed
dramatically since the release of these newer drugs [43,54].