HIV/AIDS Therapy: Drug Cocktail Benefits Women With Advanced HIV/AIDS

According to new US study of 1,132 HIV-infected women, women with advanced-stage HIV can benefit greatly from highly-active antiretroviral therapy (HAART) treatment. "Prior to this study, it was believed that many patients with advanced-stage HIV would not do very well with HAART," noted Dr. Kathryn Anastos, principal investigator in the 6-year, National Institutes of Health-sponsored study, and an attending physician and associate professor of medicine and epidemiology at Montefiore Medical Center. "Our study shows that is not the case. It is tremendously exciting news for patients who, for a variety of reasons, do not start HIV therapy early."

To assess the effectiveness of HAART, the researchers measured HIV markers in the blood of patients. "We found that low CD4+ counts and high viral load prior to treatment do not matter in determining the outcome for HIV-infected patients, as long as those numbers improved," Anastos said. "Only post-HAART treatment levels of these markers matter in determining a patient's chances of survival."

Anastos and colleagues found that, "Even in women with advanced immunologic abnormalities, HAART that raises the CD4+ cell count to greater than 200 cells/microl and reduces HIV-1 RNA levels to less than 10,000 copies/mL effectively mitigates the negative prognosis associated with low CD4+ cell counts and high HIV-1 RNA prior to therapy."

However, "There are still some patients who do not respond to therapy with improved laboratory values of CD4+ count and viral load, and thus may not do well clinically," the authors wrote.

The importance of the study was underscored by an accompanying editorial that noted that many HIV-infected patients in the United States are not receiving treatment until after they become sick with AIDS. For these patients, the editorial states, the study is "encouraging because it shows them that most patients with very late-stage illness benefit from antiretroviral therapy." The researchers used data from the Women's Interagency HIV study, the nation's largest ongoing study of women and AIDS, now in its 11th year.

The study, "The Prognostic Importance of Changes in CD4+ Cell Count and HIV-1 RNA Level in Women After Initiating Highly Active Antiretroviral Therapy," was published in the Annals of Internal Medicine (2004;140(4):256-264).

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