AIDS 2004; Bangkok, Thailand; July 11-16, 2004

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The Body PRO Covers: The XV International AIDS Conference

Patients Beginning HAART With a Low CD4+ Cell Count Respond Well

July 12, 2004

In the era of HAART, countless studies have shown that both HIV-related morbidity and mortality have dramatically decreased. Most patients today are diagnosed early and therapy is initiated before they develop any opportunistic infections (OIs). However, a small number of patients receive an AIDS diagnosis at the same time that they find out they are HIV positive. Some studies have shown that these patients who have an advanced case of HIV and a low CD4+ cell count may not respond well to antiretroviral treatment. This may be explained by poor immune recovery and higher incidence of drug-related complications. However, most clinical trials exclude patients who have a very low CD4+ cell count; thus, our data is limited on those patients.

This retrospective study looks at all 677 patients newly diagnosed with HIV who attended a clinic at the Royal Free Hospital in London between January 1996 and December 2002 and compares late presenters (those with an initial CD4+ cell count of <50 at their first clinic visit) and non-late presenters (those with an initial CD4+ cell count of >50 at their first clinic visit). One hundred late presenters (14.8%) were identified.

The researchers found that the late presenters were more likely to be older (age 36 vs. 33), female (33% vs. 24%), heterosexual (50% vs. 37%), and black African (39% vs. 27%). The majority (57%) of late presenters had an AIDS diagnosis compared to only 7% of the non-late presenters. Late presenters commonly had Pneumocystis carinii pneumonia, while tuberculosis and Kaposi's sarcoma were more common in non-late presenters. Fifty-two late presenters were hospitalized at least once.

Eighty-nine of the late presenters started HAART: 48% received a protease inhibitor and 35% received a non-nucleoside reverse transcriptase inhibitor (NNRTI)-containing regimen. The majority of patients who did not start HAART actually did not have the chance to do so because they died shortly after their first clinic visit. However, patients who survived long enough to receive HAART actually did quite well -- 85% had an undetectable viral load (below 400 copies/mL) and the median CD4+ cell count increased from 22 to 180 cells/mm3 over a year.

The risk factors for the late presenters in this study, which, as mentioned, were identified as being older, heterosexual, black African and female, reflect a trend in new HIV cases in the United States. Current preventive programs, including both early HIV testing and education, should strongly target this population. The good news is that despite their late diagnoses, the patients with a low CD4+ cell count who survived OIs to receive HAART responded well both virologically and immunologically.

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Abstract: Late Presenters With HIV in the Era of HAART: How Effective Is Therapy? (Poster MoPeB3356)
Authored by: C A Sabin, H Gumley, M Youle, C J Smith, F Lampe, A N Phillips, M A Johnson

This article was provided by It is a part of the publication The XV International AIDS Conference.

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