AIDS Clinical Trials Group study 384 was a large study with six treatment groups that examined initial treatment of human immunodeficiency virus type 1 (HIV-1) infection with one of two four-drug regimens or one of four combinations of two consecutive three-drug regimens. In this issue of the Journal, there are two reports. The first report shows that the zidovudine–lamivudine–efavirenz regimen is superior to the other three drug regimens for initial treatment. The second indicates that a four-drug regimen does not increase the duration of successful treatment.

A patient's greatest chance for successful treatment of HIV-1 occurs with the first regimen that is used. The findings from this important research will help to guide the important choice of regimen in the initial treatment of patients with HIV.

Unstable coronary-artery plaques, which are prone to rupture, are believed to have a key role in the pathogenesis of acute myocardial infarction. Hemorrhage into plaques is one mechanism by which they become unstable and progress. This study provides evidence that plaque hemorrhage causes plaques to become unstable by inducing the formation of cholesterol crystals and the recruitment of macrophages.

The central role of plaque hemorrhage in unstable coronary disease opens new lines of thought aimed at the prevention of this pathologic process.

Chronic allograft nephropathy has become the dominant cause of kidney-transplant failure in the present era of improved immunosuppression. This prospective study examined 961 kidney-transplant–biopsy specimens obtained sequentially during the first 10 years after transplantation from 120 recipients with type 1 diabetes. Nephrotoxicity, implicated in late, ongoing injury, was almost universal at 10 years, even in grafts with excellent early histologic findings.

Chronic allograft nephropathy represents cumulative and incremental damage to nephrons from time-dependent immunologic and nonimmunologic causes.

Three patients with hypereosinophilia and severe eosinophilic dermatitis in whom a variety of conventional treatments were ineffective had a rapid response to infusions of a humanized anti–interleukin-5 antibody. None of the patients had evidence of a clonal T-cell disorder or a myeloproliferative disease.

Apart from their clinical interest, these results point to the role of interleukin-5, a factor essential for the growth and differentiation of eosinophils, in a variant of the hypereosinophilic syndrome in which severe dermatitis is the predominant problem.

A promising new method of silencing gene expression has been shown to be an effective therapy in two mouse models of autoimmune hepatitis and hepatitis B infection.

Every year there are approximately 2200 to 3000 cases of invasive meningococcal disease in the United States. Because of its low cost effectiveness and other limitations, routine use of the meningococcal vaccine is not recommended. However, individual choices may differ from public policy considerations. If parents were aware of this option, many might choose to pay for vaccination in order to protect adolescents and young adults from this devastating infection. Parents and patients need information about the availability of all effective vaccines.