|
HIV
Level After 4 Weeks of HAART Predicts Eventual Virologic Outcome
By
Will Boggs, MD
Viral
load after 4 weeks of highly active antiretroviral therapy (HAART)
predicts virologic outcome at 24 weeks in individuals infected with
HIV, according to a report in the September 1st issue of the Journal
of Acquired Immune Deficiency Syndromes.
Previous
studies investigating the association between early measurements
of viral load or early viral decay rate and longer-term virologic
outcome have yielded inconsistent results, the authors explain.
Colette
J. Smith from Royal Free and University College Medical School,
London, and colleagues investigated whether viral loads measured
after 4 weeks of HAART would predict virological
suppression to below 50 copies/mL after 24 weeks
of HAART in more than 650 previously antiretroviral-naïve patients.
Nearly
three quarters of the patients had attained a viral load below 50
copies/mL by week 24 of treatment, the authors report, but only
51 patients (8%) reached this level during the first 4 weeks of
therapy.
Patients
attaining a low viral load at week 4 were significantly more likely
to achieve virologic suppression at week 24 than patients with high
viral load at week 4, the report indicates.
Eighty-six
percent of the patients with viral load below 50 copies/mL at 4
weeks retained virologic suppression at 24 weeks, compared with
only 61% of patients with a week 4 viral load between 1001 and 10,000
copies/mL.
Every
1-log higher viral load at week 4 was associated with a 3-fold decrease
in the odds of attaining a viral load of less than 50 copies/mL
at week 24, the researchers note. In a multivariate regression model,
week 4 viral load was the only variable associated with the week
24 virologic outcome.
"Our
study highlights that early measurements of viral load enables early
prediction of virologic
response to HAART and so will allow reasons for a
poor early response to be investigated and addressed as necessary,"
Smith told Reuters Health.
"Reasons
for a negative response may include adherence,
tolerability, drug levels, and drug
resistance," the investigators conclude. "Early
prediction should enable these potential causes to be investigated
and, if necessary, addressed."
10/27/04
J
Acquir Immune Defic Syndr 2004;37:1155-1159.
|
