August 29, 2003
Prognosis for HIV/AIDS patients might be better determined after the patient has received six months of antiretroviral therapy rather than before the patient has begun treatment, according to a study published in the Aug. 30 issue of the Lancet, according to a University of Bern release. The Antiretroviral Therapy Cohort Collaboration, including Matthias Egger, a professor in the Department of Social and Preventive Medicine at the University of Bern, and colleagues, examined 13 cohort studies from Europe and North America, which involved 9,323 adult patients who had never before received highly active antiretroviral treatment and were starting HAART with three antiretroviral drugs (University of Bern release, 8/28). Researchers measured HIV/AIDS progression beginning with month six after beginning antiretroviral therapy, comparing CD4+ T cell count and HIV viral load at the beginning of the study and at six months. Over the course of the studies, 152 patients died and 874 developed AIDS. As expected, patients with higher CD4+ T cell counts had a lower risk of dying or developing AIDS six months after starting antiretroviral therapy, compared with patients with CD4+ T cell counts less than 100 per milliliter, according to the study. However, patients' CD4+ T cell counts and viral loads as measured before the start of HAART were not indicative of prognosis once the six-month prognosis was taken into account. Researchers concluded that the findings should be used to develop guidelines on when to modify antiretroviral treatments. Egger said, "At six months after starting HAART, the current CD4 cell count and viral load, but not the values at baseline, are strongly associated with subsequent disease progression. Our findings should inform guidelines on when to modify HAART" (Egger et al., Lancet, 8/30).
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