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Being Alive

News from Here and There: Swiss Study Shows CD4 Increase Despite Protease Inhibitor "Failure"


SO Being Alive 1998 May 5: 11

A study of the medical records of 98 patients treated for 48 weeks found substantial increases in CD4 count even for those whose viral loads never became undetectable. The patients whose treatment was interrupted had a much smaller CD4 benefit. These results add to the suggestions from elsewhere that highly active antiretroviral treatment (HAART) can provide benefit even if the virus is not completely suppressed.

When they started HAART treatment, the 98 patients had a CD4 count baseline averaging about 162-and about 66% of them did not have complete suppression of their viral load. All had extensive prior treatment with antiretrovirals such as AZT. Eighty-two took a protease-inhibitor-containing regimen continuously for the 48 weeks; the other 16 had interruptions in treatment averaging 55 days.

Those whose virus became persistently undetectable had a CD4 increase of 138. Those whose virus only transiently became undetectable had an increase of 132. Those who took therapy continuously despite never achieving undetectable viral load had an average increase of 105. The 16 patients who interrupted therapy had an average CD4 increase of 57.

This study does not answer the question of whether the still-replicating virus will be able to become more resistant later and fully negate the value of the drugs-or whether the drug- resistant virus is damaged or less pathogenic in some way, allowing the treatment to be of value indefinitely even if undetectable viral load is not reached or maintained. Clearly long-term data will be needed.

Meanwhile, it would help to have more detailed analyses of CD4 changes which occur at different viral loads, both in patients on treatment and off-and also data on how detectable viremia tends to progress over time in patients who remain on therapy. Currently, the standard goal of treatment is to achieve an undetectable viral load (using the most sensitive test available); the reason for this goal is that any detectable viral load means that the virus is replicating in the presence of the drug, and therefore may become more resistant. But since about half of heavily pretreated patients have been unable to reach an undetectable viral load, and yet do appear to be benefiting from the treatment anyway, we need more research on how to manage the therapy in this case. [AIDS Treatment News Issue No. 291, March 20, 1998]


Information in this article was accurate in May 5, 1998. The state of the art may have changed since the publication date. This material is designed to support, not replace, the relationship that exists between you and your doctor. Always discuss treatment options with a doctor who specializes in treating HIV.