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EARLY ASSESSMENT PREDICTS LONG-TERM EFFICACY OF HIV-1 ANTIRETROVIRAL THERAPY (p 1760)
November 21, 2001A study in this week's issue of THE LANCET highlights how very early (one week) assessment can reliably predict the long-term effectiveness of antiretroviral therapy for HIV-1.
Early assessment of antiretroviral drug efficacy is important for the prevention of the emergence of drug-resistant virus and unnecessary exposure to ineffective and toxic drugs. Current US guidelines for changing therapy are based on measurements of plasma HIV-1 RNA concentrations 4 or 8 weeks after the start of treatment. Michael Polis, Dimiter Dimitrov, and colleagues from the US National Institute of Allergy and Infectious Diseases, and the National Cancer Institute, Bethesda, USA, investigated whether it was possible to assess drug efficacy from measurements of plasma HIV-1 concentrations made during the first week on therapy.
The virus decay rate at 6 days after the start of antiretroviral therapy was associated with changes in HIV-1 concentrations at 4, 8, and 12 weeks. Reduction in plasma HIV-1 of less than 0.72 log by day 6 after initiation of therapy predicted poor long-term responses in more than 99% of patients.
Dimiter Dimitrov comments: "These results suggest that changes in HIV-1 concentration at day 6 after treatment initiation are major correlates of longer-term virological responses. They offer a very early measure of individual long-term responses, suggesting that treatment could be optimised after only a few days of therapy."
Lancet
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