AEGiS-13IAC: Full plasma viral load suppression is needed to achieve an optimal CD4 response among patients receiving triple drug antiretroviral therapy.

13th International AIDS Conference

Durban, South Africa - July 9-July 14, 2000

Full plasma viral load suppression is needed to achieve an optimal CD4 response among patients receiving triple drug antiretroviral therapy.

Int Conf AIDS 2000 Jul 9-14; 13:(abstract no. WeOrB609)

Montessori V, Wood E, Yip B, Hogg R, Sherlock C, Jahnke N, Harrigan R, O'Shaughnessy M, Montaner J
J. Montaner, British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard St, Vancouver BC, V6Z 1Y6, Canada, Tel.: +1 604 631 5516

BACKGROUND: It has been reported that continued antiretroviral therapy in patients with persistently elevated viral loads may be associated with improvements in CD4 cell counts. We have evaluated the relationship between the degree of plasma viral load suppression achieved by HIV-1 infected patients initiating triple drug antiretroviral therapy, and the accompanying changes in CD4 cell counts.

METHODS: Retrospective study of 465 participants in the BC Centre for Excellence in HIV/AIDS Drug Treatment Program. Patients were divided into three groups according to their plasma viral load response: 1) Non-Responders (NRs; n = 112) exhibited plasma viral load persistently > 500 c/mL over the study period, 2) Partial Responders (PRs; n = 100) achieved a pVL > 500 c/mL at least once, and subsequently rebounded to > 500 c/mL, and 3) Full Responders (FRs; n = 253) achieved a pVL > 500 c/mL and sustained this level. We evaluated the accompanying changes in absolute and fractional CD4 cell counts.

RESULTS: The median net change in pVL per person from baseline to the end of the observation period was -0.37, -2.27, and -2.56 log₁₀ for NRs, PRs, and FRs respectively. During week 68 to 83, 55% of the PRs had pVL > 500 c/mL, while 100% of the FRs had pVL > 500 c/mL. During the same time period, the median CD4 count was 150 (IQR: 90 to 370), 380 (IQR: 300 to 480), and 525 (IQR: 305 to 705) cells/mm³ for NRs, PRs, and FRs, respectively. Median changes in CD4 were -20 (IQR: -90 to 40), 150 (IQR: 30 to 250), and 240 (IQR: 110 to 365) cells/mm³ for NRs, PRs, and FRs. The median CD4 cell count from all three groups were statistically different when compared among each other. The net percent change in CD4 per person was 0% (IQR: -34 to 31%), 54% (IQR: 6 to 160%), and 83% (IQR: 39 to 173%) for NRs, PRs, and FRs, respectively. Of note, Full Responders achieved this result with the least overall drug exposure.

CONCLUSIONS: Although the management of HIV-1 infected patients showing detectable viral load while on therapy remains controversial, our data indicate that suppression of viral replication should remain the primary goal of therapy.

Keywords: AEGIS, Viral Load, CD4 Lymphocyte Count, Anti-HIV Agents, Antigens, CD4, HIV-1, HIV Infections, Antiretroviral Therapy, Highly Active, HIV, Drug Therapy, Combination, Retrospective Studies, Human, drug therapy, immunology
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