Long-term CD4+Tcell response in HIV-1infected patients continuing on combination antiretroviral therapy despite high-level viremia and drug resistance.
Int Conf AIDS 2002 Jul 7-12; 14:(abstract no.. B10190)
Dionisio D, Vivarelli A, Zazzi M, Esperti F, Uberti M, Fabbri C Pistoia General Hospital, Pistoia, Italy
The benefit of highly active antiretroviral therapy (HAART) in HIV-1 infection has been linked to its complete suppression of viral replication, though durable HIV treatment benefit despite low-level viremia has been reported. HAART often leads to increases in CD4+ T cell count of 100-200 cells/ml or more, even though individual responses are quite variable. CD4+ T cell responses are generally related to the degree of viral load suppression. However, data from several studies suggest that a substantial proportion of people taking HAART had persistently detectable viremia in spite of the strict adherence to treatment . What happens to those who remain highly viremic while taking HAART is not fully understood, though sustained CD4+ T cell response in patients (pts) taking protease inhibitor (PI)-based regimens has been reported . Diminished "fitness" of heavily mutated viruses (that is, reduced ability of resistant virus to replicate and deplete CD4+T cells) could partly explain these observations. If confirmed, these findings would suggest that discontinuing HAART in individuals remaining highly viremic would be no longer appropriate . Present limitations in treatment options due to the broad, either manifest or occult, cross resistance within each class of antiretroviral drugs (ARDs) further enhances the implications of such a conceptual framework . To date, the durability of these immunologic responses that occur despite failure of virological suppression is unknown, though at least 24-month benefit has been reported in pts continuing on PI-containing regimens. Long-term follow-up studies that include monitoring of drug resistance while continuing on HAART are required to expand information in this setting. We report the results of a 36-month observational study performed on 16 pts who had sustained CD4+T cell response despite high-level viremia and extensive drug resistance while continuing on combination antiretroviral therapy
Keywords: AEGIS, Viremia, HIV Infections, Antiretroviral Therapy, Highly Active, Viral Load, CD4 Lymphocyte Count, HIV Seropositivity, T-Lymphocytes, Virus Replication, Human, virology
