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]