Timely antiretroviral therapy essential for best prognosis in people with HIV-1 infection

July 11, 2002

Authors of an international study in this week's issue of THE LANCET highlight how timely treatment with highly-active antiretroviral therapy (HAART) can substantially improve the three-year prognosis for people with HIV-1 infection.

HAART became widespread in more-developed countries in 1996. However, there is insufficient data from individual studies to estimate the prognosis of people with HIV-1 infection starting HAART. The ART Cohort Collaboration, led by Matthias Egger from the University of Bern, Switzerland, was established to fill this knowledge gap.

The investigators analysed data on over 12,000 adult patients from 13 prospective studies from Europe and North America. The patients had not received antiretroviral therapy previously and started HAART with a combination of at least three drugs. 870 patients developed a new AIDS event and 344 patients died.

More advanced disease-as demonstrated by a low CD4 white blood cell count at the beginning of HAART-was strongly associated with the probability of progression to AIDS or death. Compared with patients starting HAART with less than 50 CD4 cells per microlitre, patients with a CD4 count between 50 and 99 per microlitre had around a 25% relative reduction in risk of AIDS or death; those with counts between 100 and 199 had around a 50% relative risk reduction, whereas patients with initial CD4 cell counts above 200 per microlitre had a relative risk reduction of around 80%. A blood concentration of the HIV-1 virus above 100,000 copies per millilitre at the start of therapy was also associated with a higher probability of progression to AIDS or death. Other independent predictors of poorer outcome were advanced age, HIV-1 infection through injection drug use, and a previous diagnosis of AIDS. Overall, the probability of progression to AIDS or death at 3 years ranged from 3% for patients in the lowest risk category for all prognostic variables, to 50% for patients at the highest risk.

Matthias Egger comments: "This study is important because it helps to define when exactly in the course of the infection HAART should be initiated. Unfortunately, almost 60% of patients in our study were late and started with a CD4 cell count below 200 cells or a viral load above 100,000 copies. In these patients the treatment would have been more effective had it been started earlier. We now need to address the reasons responsible for the delay in treatment in order to maximise benefit from current antiretroviral therapy".
-end-
Contact: Professor Matthias Egger, c/o Department of Social Medicine, University of Bristol, Canynge Hall, Whiteladies Road, BRISTOL BS8 2PR, UK; T) +44 (0)117 928 7387 or +44 (0) 117 962 8576 (home); F) +44 (0)117 928 7325; E) egger@ispm.unibe.ch

Lancet

Related Aids Articles from Brightsurf:

Developing a new vaccination strategy against AIDS
Infection researchers from the German Primate Center (DPZ) -- Leibniz Institute for Primate Research have in cooperation with international colleagues tested a new vaccination strategy against the HIV-related simian immunodeficiency virus (SIV) in rhesus monkeys.

HIV-AIDS: Following your gut
Researchers find a way to reduce replication of the AIDS virus in the gastrointestinal tract.

A path toward ending AIDS in the US by 2025
Using prevention surveillance data to model rates of HIV incidence, prevalence and mortality, investigators at Brigham and Women's Hospital and Johns Hopkins Bloomberg School of Public Health set targets, specifically a decrease in new infections to 21,000 by 2020 and to 12,000 by 2025, that would mark a transition toward ending the HIV/AIDS epidemic.

What does it take for an AIDS virus to infect a person?
Researchers examined the characteristics of HIV-1 strains that were successful in traversing the genital mucosa that forms a boundary to entry by viruses and bacteria.

How AIDS conquered North America
A new technique that allowed researchers to analyze genetic material from serum samples of HIV patients taken before AIDS was known provides a glimpse of unprecedented detail into the beginnings of the AIDS epidemic in North America.

New research could help build better hearing aids
Scientists at Binghamton University, State University of New York want to improve sensor technology critical to billions of devices made every year.

NY State Department of Health AIDS Institute funds HIV/AIDS prevention in high-risk youth
NewYork-Presbyterian's Comprehensive Health Program and Project STAY, an initiative of the Harlem Heath Promotion Center (HHPC) at Columbia University's Mailman School of Public Health has received two grants totaling more than $3.75 million from the New York State Department of Health AIDS Institute for their continued efforts to prevent HIV/AIDS in at-risk youth.

A new way to nip AIDS in the bud
When new HIV particles bud from an infected cell, the enzyme protease activates to help the viruses infect more cells.

AIDS research prize for Warwick academic
A researcher at the University of Warwick has received international recognition for his contribution to AIDS research.

Insects inspire next generation of hearing aids
An insect-inspired microphone that can tackle the problem of locating sounds and eliminate background noise is set to revolutionize modern-day hearing aid systems.

Read More: Aids News and Aids Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.