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and Hepatitis.com Coverage of the
XVIII International AIDS Conference (AIDS 2010) July 18 - 23, 2010, Vienna, Austria
Long-term Non-progression of HIV Disease without Antiretroviral Treatment Is Uncommon
Jannie van der Helm and fellow investigators with the CASCADE Collaboration estimated progression-free survival among cohort participants with accurate dates of HIV seroconversion. Most prior studies of long-term non-progression (LTNP) used a cross-sectional (single point in time) approach and seroconversion dates were often uncertain.
CASCADE is an ongoing natural history study of HIV seroconverters from more than 2 dozen clinical cohorts in Europe, Australia, and Canada followed since the widespread adoption of combination ART in the late 1990s.
This analysis included 6506 participants who potentially had 10 or more years of follow-up based on their presumed seroconversion date. Data were collected through December 2008. Most (77%) were men, the average age at the time of seroconversion was 28 years, about half were men who have sex with men, and about one-quarter were injection drug users.
The researchers classified participants according to LTNP status, defined as being HIV positive without progression for at least 10 years following seroconversion. They then identified the likelihood of and factors associated with disease progression, defined as CD4 cell count falling below 500 cells/mm3, ART initiation, or an AIDS-defining event, whichever came first.
Based on these findings, the investigators concluded that progression-free survival is uncommon, with "gradual but inexorable loss of LTNP status over time."
Even those participants with immunological and clinical control of HIV during the first 10 years after seroconversion seemed to lose this control rapidly thereafter, they added.
Studies of individuals with long-term non-progression and durable viral control, they suggested, might contribute to the development of preventive and therapeutic HIV vaccines.
affiliations: Health Service Amsterdam, Research, Amsterdam, Netherlands;
MRC Clinical Trails Unit, London, UK; Academic Medical Center, University
of Amsterdam, Amsterdam, Netherlands; Service d'Epidémiologie
et de Santé Publique, Université Paris, Paris, France;
Royal Free & University College Medical School, London, UK; Robert
Koch Institute, Berlin, Germany; Università degli Strudi di Milano
H.S. Paolo, Milan, Italy.