Fifth International Congress Drug Therapy in HIV Infection 22-26 October, 2000 Glasgow, UK

Viral load changes in response to antiretroviral therapy according to the baseline CD4 lymphocyte count and viral load

A.N. Phillips, S. Staszewski, R.Weber, O. Kirk, P. Francioli, V. Miller, P. Vernazza, J. Lundgren and B. Ledergerber on behalf of the Swiss HIV Cohort Study, the Frankfurt HIV Clinic Cohort and the EuroSIDA Study Group
1Royal Free & University College Medical School, London NW3 2PF, UK

Int Cong Drug Therapy HIV 2000 Oct 22-26;5:Abstract No. PL3.4
AIDS 2000, Oct 22-26;14(Suppl. 4);S3

Precise characterization of the relationship between baseline CD4 count/ viral load and viral load response would provide information for the decision of when to initiate antiretroviral therapy. We studied 2742 therapy-naïve individuals from three clinic-based cohort studies who initiated antiretroviral therapy in 1996 or after and have been followed for a median of 101 weeks. The virological response was assessed in terms of the time to virological suppression < copies /ml within 32 weeks and, in people in whom such suppression was achieved, the time to viral load rebound > 500 copies/ml on two consecutive occasions. Survival analysis techniques were used to assess the relationship between baseline CD4 count/viral load and these responses. 2346 (86%) patients experienced viral suppression to < 500 copies /ml by 32 weeks. Relative hazards (in a Cox model containing viral load, age, sex, exposure category, 3/≥4 drugs, previous AIDS, use of saquinavir hgc, calendar year and stratified for clinic) of achieving this were 1.07 (95% CI 0.96– 1.20) and 0.88 (0.79–0.99) for baseline CD4 count 200–349/mm³ and < 200/mm³, respectively, compared with ≥350/mm³. For baseline viral load the relative hazards were 1.03 (0.90–1.18) and 0.70 (0.61–0.80), for baseline viral load 10 000–99 999 and ≥ 100 0000, respectively, compared with < 10 000 copies /ml. Of those with viral load suppression < 500 copies/ml, 461 (20%) subsequently experienced viral rebound > 500 copies /ml. There was no trend for increasing rate of rebound with lower baseline CD4 count or higher viral load after adjustment for other relevant factors. In conclusion, so long as the CD4 count remains above 200/mm³ and the viral load remains below 100 000 copies/ml, there is no evidence that lower CD4 counts and higher viral loads are associated with poorer virologic responses to therapy

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2000-10-22
PL3-4

Originally published in AIDS Volume 14, Supplement 4 and hosted with permission of the publisher Lippincott Williams & Wilkins, 250 Waterloo Road, London, SE1 8RD, UK. Tel: +44 (0)20 7981 0700 Fax: +44 (0) 7981 0701

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