Immune Failure Delayed by Continuing Treatment With PI After Virologic Failure -- HIV/AIDS INFO AND UPDATES

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Date Posted: 22:15:53 02/28/02 Thu
Author: Anonymous
Subject: Immune Failure Delayed by Continuing Treatment With PI After Virologic Failure

Immune Failure Delayed by Continuing Treatment With PI After Virologic Failure

NEW YORK (Reuters Health) Feb 19 - CD4+ cell counts stay elevated longer when patients who experience virologic failure while on at least one protease inhibitor (PI) continue to take medication rather than stopping therapy altogether, according to California investigators.

Dr. Steven G. Deeks and associates, of the University of California, San Francisco, followed 291 patients who maintained CD4+ cell counts higher than their pre-therapy counts, despite virologic failure.

As the researchers report in the January 25th issue of AIDS, the median time to immunologic failure--return of CD4+ cell counts to below those measured before PI treatment was initiated--was 3.1 years. However, only 36.8% of patients who remained on therapy experienced immunological failure by 3 years.

"This observation suggests that therapy selects for a virus with reduced ability to deplete CD4 T cells (i.e., reduced virulence or reduced pathogenicity)," the California research team posits.

The time to immunologic failure was also associated with the change in viral load from a pre-therapy baseline, such that those with a smaller degree of viral suppression exhibited a higher risk of decline in CD4+ cell counts. The absolute level of viremia after virologic failure was a less significant factor, the authors report.

"Compared to patients with a plasma HIV RNA level <2.98 log-10 copies/mL, only those with the very highest levels of viremia (> 4.5 log-10 copies/mL) were at increased risk of immunologic failure after adjustment for the change in HIV RNA levels from pre-therapy levels," the investigators write.

Based on these estimations, Dr. Deeks and his colleagues suggest that current recommendations to switch therapy as soon as virologic failure occurs may not be practical for many patients. "Our data provide support for a more conservative strategy, particularly for those patients with limited therapeutic options," they recommend.

AIDS 2002;16:201-207.

Reuters Health Information 2002. � 2002 Reuters Ltd
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