6 Months Key to Predicting HIV Prognosis
Making Predictions After Start of HIV Treatment May Be Better
Aug. 28, 2003 -- When it comes to predicting how someone with
HIV is going to do in the long run, it's best to wait until six months after
the start of HIV treatment.
In fact, researchers found that initial blood tests may be less
important than improvements achieved during the first months of HIV
New-generation drugs for HIV have been the standard in HIV
treatment in developed countries since the late 1990s. This type of HIV
treatment involves a using a minimum of three powerful anti-HIV drugs to lower
the level of HIV circulating in the body and thus boost the immune system.
First Months of HIV Treatment Critical
In this study, published in The Lancet, researchers
analyzed 13 studies from Europe and North America involving 9,000 patients
receiving HIV treatment.
The level of infection-fighting immune cells called CD4 cells
as well as the amount of HIV circulating in the patient's body -- known as the
viral load -- was measured at the start of HIV treatment and six months
Researchers say that, in general, the lower the CD4 count and
the higher the viral load, the worse the prognosis for HIV patients is thought
to be. HIV treatment decreases the viral load while increasing the level of
immune cells necessary to fight infection.
Typically, researchers say that doctors make predictions about
a patient's future based on their CD4 counts and viral load at the start of HIV
But the researchers discovered that only measurements of CD4
cells and viral load taken six months after initiating HIV treatment were
predictive of the patient's disease progression -- not those taken at the start
"In other words, it matters what CD4 count and viral load a
patient arrives at, but not where the patient was when starting [HIV
treatment]," write researcher Matthias Egger, of the University of Bern and
the Antiretroviral Therapy Cohort Collaboration. "This should be seen as a
positive message, which might help to motivate patients to adhere to treatment
Patients with low CD4 counts (less than 100) after six months
of HIV treatment had a significantly worse prognosis than those with higher
immune cell counts. Other factors that indicated a faster progression to AIDS
- Age over 50 years
- HIV infection through injection drug use
- AIDS diagnosis before or within six months of the start of HIV
Researchers say the findings should also help doctors know when
more aggressive HIV treatment might be necessary, such as in people with HIV
who do not show significant improvement within the first six months.