Important note: Information in this article was accurate in March 2000. The state of the art may have changed since the publication date.
TreatmentUpdate 106 - 2000 March; Volume 12 Issue 2
Hosein SR
Although HAART can help decrease the risk of life-threatening infections and death in people with HIV/AIDS, serious illnesses still occur in some people who take HAART. To find out which people with HIV/AIDS are at risk for AIDS-related infections while taking HAART, researchers in Switzerland collected data on nearly 2,500 subjects. In analysing the data, the researchers found several factors that could be used to help assess risk levels for AIDS-related infections. First, they found that CD4+ cell levels at the start of therapy could be used to predict the risk of AIDS-related infections. Second, regardless of the CD4+ count at the start of therapy, they observed that an increase of at least 50 cells and a fall in viral load below the 400-copy mark after six months greatly reduced the risk of developing infections.
Researchers used data on 2,410 subjects who had the following characteristics at the time they entered the study:
The following protease inhibitors were used in the following proportion of subjects:
Overall, the researchers noted a dramatic decrease in the number of life-threatening complications once subjects began to use HAART. The decline in infections was statistically significant for nearly all AIDS-related illnesses with the exception of a form of cancer called non-Hodgkin's lymphoma (NHL).
A total of 143 subjects developed 186 serious infections. The most common AIDS-related illnesses were:
Readers should note that while early reductions in the risk of developing AIDS-related illnesses occurred for many conditions, such a an early reduction did not occur for the following:
This was perhaps due to continued immune dysfunction despite the use of HAART. This observation is not surprising given data from Norway that suggest that HAART does not completely reverse HIV-related immune dysfunction.
Researchers looked at factors that may have affected the development of AIDS-related illnesses. After 2½ years of HAART, the risk of developing infections could be calculated based on the subjects' initial CD4+ counts. The results of these calculations look like this:
Subjects whose CD4+ count rose by at least 50 cells after six months of therapy and whose viral load fell below 400 copies had a greatly reduced risk of developing serious infections.
1. Stylianou E, Aukrust P, Kvale D, et al. IL-10 in HIV infection: increasing serum IL-10 levels with disease progression-down-regulatory effect of potent anti-retroviral therapy. Clinical and Experimental Immunology 1999;116(1):115-120.
2. Ledergerber B, Telenti A, and Egger M. Risk of HIV-related Kaposi's sarcoma and non-Hodgkin's lymphoma with potent antiretroviral therapy: prospective cohort study. British Medical Journal 1999;319(7201):23-24.
3. Ledergerber B, Egger M, Erad V, et al. AIDS-related opportunistic illnesses occurring after initiation of potent antiretroviral therapy: the Swiss cohort study. Journal of the American Medical Association 1999;282:2220-2226.
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Copyright © 2000 - TreatmentUpdate. Reproduced with permission. Reproduction of this article (other than one copy for personal reference) must be cleared through the Editor, The Canadian AIDS Treatment Information Exchange, 555 Richmond St. West, Suite 505, Box 1104, Toronto, ON, M5V 3B1 • Phone: 416-203-7122 • Toll Free: 1-800-263-1638 • Fax: 416-203-8284 http://www.catie.ca
Disclaimer: The editors have taken all such care as they consider reasonable in preparing this database, but they cannot be held responsible for any inaccuracies or mis-statements of fact contained herein. Inclusion in this database of any information on any treatment, therapy, or clinical trial in no way represents an endorsement of that treatment, therapy, or trial by ÆGiS or any of its sponsors. This data should always be used in conjunction with professional medical advice.