Discordant
or No Responses
to HAART Increases
Risk of Disease
Progression
By
Brian Boyle,
MD
Discordant
immunologic
and virologic
responses to
HAART
occur in a small
portion of HIV-infected
patients. In
a study presented
at the 13th
CROI, the prevalence
and prognostic
value of these
responses was
examined in
a cohort of
injecting
drug users (IDU).
The
study cohort
was derived
from a cohort
of HIV-infected
IDUs that has
been evaluated
semi-annually
since 1988.
The investigators
evaluated patients
who initiated
HAART from 1996-2000.
Virologic (HIV
RNA <1000
copies/mL) and
immunologic
(CD4 >500
cells/ l or
increase of
50 cells/ L
from HAART initiation)
responses were
examined in
the first years
of HAART.
Among
265 patients
who were studied
the median age
was 43 years,
71% were male
and 94% African
American. In
the first year,
35% had both
a virologic
response and
an immunologic
response, 21%
had an immunologic
response only,
16% had a virologic
response only,
and 29% had
no response.
Compared to
nonresponders,
those with any
response had
a significantly
higher pre-HAART
CD4 and lower
HIV RNA.
Persons
with CD4 response
were also significantly
less likely
to report current
IDU (38%) than
those without
CD4 response
(53%, p = 0.01).
Compared
to non-responders
and those with
discordant responses,
subjects with
early combined
response were
more likely
to have combined
response in
the second year.
After adjusting
for pre-HAART
CD4, compared
to non-responders,
those with combined
response had
significantly
reduced risk
of disease progression.
Those
with only immunologic
and virologic
response had
reduced risk
of progression
compared to
non-responders
but experienced
faster progression
than those with
a combined response.
The
authors conclude,
"Early
discordant virologic
and immunologic
responses were
common in this
population.
In contrast
to reports from
other cohorts,
progression
rates for discordant
groups did not
differ substantially
by whether early
response was
immunologic
or virologic.
Despite low
rates of sustained
HAART responses
beyond the first
year and high
rates of HAART
discontinuation,
early virologic
and immunologic
response conferred
substantial
survival benefit."
02/14/06
Reference
S
Mehta and others.
Discordant Responses
to HAART and
Clinical Outcomes
among Injection
Drug Users in
Baltimore, Maryland.
13th Conference
on Retroviruses
and Opportunistic
Infections.
Denver, CO.
February 5-8,
2006. Abstract
527
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