February 6, 2001
One of the ways that we monitor our successes and limitations is through studies that simply monitor large numbers of people getting care for HIV infection in medical centers across the U.S. One of the more prolific studies in the past few years has been the HOPS study, which monitors over 6,000 people in ten HIV clinics in the U.S. Included in care are about 1,000 women, and a racial breakdown that parallels those with HIV infection in the U.S.
The focus of this presentation was to report on the continued low rates of death and illness due to HIV infection. Death and illness due to HIV had plummeted with the onset of the use of triple combination therapy, initially containing two nucleoside antivirals and a protease inhibitor and these low rates continue to be reported. (In these sites, most of the triple combinations used this combination, while about 25% were taking two NRTIs and a non-nucleoside.) The low rates of illness are not explained by the use of prophylaxis for specific opportunistic infection. In describing the durability of this benefit, they explored several factors. First was the length of time someone was able to remain on the first regimen. They noted that those who began with a CD4 count below 200 were less likely than those who initiated treatment above 200 to remain on this first combination. However, much of this difference was explained by those who were antiviral-experienced with nucleosides prior to starting a triple combination -- those whose first combination was a triple-drug regimen were equally successful at any CD4 count. They noted that most discontinuations appeared related to side effects of the medications, and this did not differ by CD4 count while on meds. Along these lines perhaps, those who started on a dual PI combination had the shortest time on the initial regimen, while there was equal time on either a PI or an NNRTI combination.
While there are increasing reports from some sites about an increased risk of illness seen in those no longer responding to antivirals, this report suggests that, overall, we are still maintaining a wall providing at least adequate immune reconstitution. Clearly, the rates of illness are nothing like they were in the era of less-effective antiviral strategies. With the ongoing realization and incorporation of what is needed to maintain the effectiveness of these meds, it is clear that all of this effort still continues to provide for a level of health in those with HIV infection not seen just a few years ago.
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