An editorial commentary in the Journal of Infectious Diseases (2004;190: 1043-5) reviews clinical trials of treatment for early, maybe asymptomatic, HIV infection. In the past decade, many clinicians believed that a cure was possible and that treatment should “hit them hard and hit them early.” That approach has been abandoned as too dangerous, but there is still no consensus on the CD4 count that should trigger intensive treatment. Sadly, most of the trials of drug treatment have been observational, rather than rigorous studies with an arm for non-intervention.

Some drugs go on for ever, and methotrexate is one of them. High dose methotrexate is the single most effective agent for the initial treatment of lymphomas of the nervous system (Clinical Cancer Research 2004;10: 5643-6). Most patients eventually relapse, but some have responded well to a further increase in the dose of the drug.

Fewer than 1% of malignant melanomas occur in the anorectal region, and patients with these tumours are usually seen by surgeons with no special experience of these rare lesions. A French study collected 40 patients in whom the median survival was 17 months (British Journal of Surgery 2004;91: 1183-7). After radical surgery—wide local excision or abdominoperineal removal of the tumour was recommended—the …