Important note: Information in this article was accurate in March 1999. The state of the art may have changed since the publication date.AIDSWEEKLY Plus; Monday, March 1, 1999
Daniel J. DeNoon, Senior Editor
Clinicians face this question for each patient responding to highly active antiretroviral therapy (HAART). When can such a patient cease taking medicines that prevent opportunistic infections (OIs)? And when should OI prophylaxis be reinstated? The answer must be based on data that only now is beginning to emerge from longitudinal studies.
"We can see that with discontinuation of prophylaxis risk seems to be diminishingly small for many opportunistic infections," said Constance Benson of the University of Colorado. "The challenge for clinicians is to identify those patients who can safely stop primary and secondary prophylaxis."
Benson spoke in a symposium on immune reconstitution at the 6th Conference on Retroviruses and Opportunistic Infections, held January 31-February 4, 1999, in Chicago, Illinois.
Benson noted that from 1996 to 1997 there was a 15 percent decrease in AIDS-defining events in the U.S.
"This is due to the decline in incidence of every opportunistic infection associated with AIDS," she said.
Benson, a noted AIDS clinical researcher since the beginning of the epidemic, said it is clear that the natural history of OIs in HIV disease has been altered by the use of HAART. But exactly how much HAART reduces the risk of an OI - and whether risk is decreased for a specific CD4 threshold - remains unknown.
However, some indications are emerging. The incidence of OIs in patients on HAART is associated with the degree of CD4 count increase. And regardless of a patient's viral load, the higher a patient's CD4 count the lower the risk of an OI.
Benson said the Spectrum of Disease Study undertaken by the U.S. Centers for Disease Control and Prevention (CDC) found that Pneumocystis carinii pneumonia (PCP) and disseminated Mycobacterium avium complex (MAC) infection occur at the same low CD4 counts for HAART patients as for untreated patients. Two independent predictors of OIs are a 0.5 log[10] decrease in viral load or no increase in CD4 after HAART initiation. Finally, patients whose viral loads are less than 5,000 copies/mL are at a low risk of progression.
"Those of us in clinical practice, however, have to deal with the exceptions," Benson warned.
990301
AW990307
Copyright © 1999 - Charles Henderson, Publisher. All rights Reserved. Permission to reproduce granted to AEGIS by Charles W. Henderson. Authorization to reproduce for personal use granted granted by C. W. Henderson, Publisher, provided that the fee of US$4.50 per copy, per page is paid directly to the Copyright Clearance Center, 27 Congress Street, Salem, Massachusetts 01970, USA. Published by Charles Henderson, Publisher. Editorial & Publishing Office: P.O. Box 5528, Atlanta, GA 30307-0528 / Telephone: (800) 633-4931; Subscription Office: P.O. Box 830409, Birmingham, AL 35283-0409 / FAX: (205) 995-1588 http://www.newsrx.net
AEGiS is made possible through unrestricted grants from Boehringer Ingelheim, iMetrikus, Inc., the National Library of Medicine, and donations from users like you. Always watch for outdated information. This article first appeared in 1999. This material is designed to support, not replace, the relationship that exists between you and your doctor.
AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.
Copyright ©1990, 2000. AEGiS & the Sisters of Saint Elizabeth of Hungary. All materials appearing on AEGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of ĘGIS, or the party credited as the provider of the content.