Journal Article

Effect of Maintaining Highly Active Antiretroviral Therapy on AIDS Events among Patients with Late-Stage HIV Infection and Inadequate Response to Therapy

Tejal Gandhi, Wei Wei, Kamal Amin and Powel Kazanjian

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 42, issue 6, pages 878-884
Published in print March 2006 | ISSN: 1058-4838
Published online March 2006 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/500210
Effect of Maintaining Highly Active Antiretroviral Therapy on AIDS Events among Patients with Late-Stage HIV Infection and Inadequate Response to Therapy

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Background. We evaluated the effect of maintaining highly active antiretroviral therapy (HAART) on the development of new acquired immunodeficiency syndrome (AIDS)-related events in patients with late-stage human immunodeficiency virus (HIV) infection who had suboptimal CD4+ cell count and viral load responses to HIV therapy.

Methods. In patients with pretreatment CD4+ cell counts of <200 cells/mm3, incidence rates of new AIDS-related events occurring during HIV treatment were calculated during period 1 (pre-HAART era, 1990–1995; 88 patients) and period 2 (HAART era, 1996–2004; 214 patients) according to CD4+ cell count responses while receiving treatment. Cox multivariate model was used to compare rates of AIDS-related events from period 2 with those from period 1 according to specific CD4+ cell count response categories and rates of AIDS-related events for various viral load ranges within CD4+ cell count categories during period 2.

Results. For period 2 patients with CD4+ cell counts <50 cells/mm3 and viral loads >100,000 copies/mL, the rate of AIDS-related events (39.3 events per 100 person-years) was significantly lower than that for period 1 patients with CD4+ cell counts <50 cells/mm3 (76.4 events per 100 person-years; P = .02). This held true for patients with CD4+ cell counts <100 cells/mm3; there were also significantly fewer AIDS-related events in period 2 (18 events per 100 person-years) than in period 1 (65.2 events per 100 person-years; P = .001), including those events occurring among period 2 patients with viral loads >100,000 copies/mL (29.5 events per 100 person-years; P = .01). Similarly, for patients with CD4+ cell counts of 100–200 cells/mm3, there were fewer AIDS-related events in period 2 (7.8 events per 100 person-years) than in period 1 (34.5 events per 100 person-years; P = .001); even for patients in period 2 with viral loads >100,000 copies/mL (15.4 events per 100 person-years; P = .04).

Conclusions. Our data suggest that, even among patients with late-stage HIV infection and inadequate CD4+ cell count and viral load responses to HIV therapy, maintaining HAART may reduce the incidence of AIDS-related events.

Journal Article.  4516 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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