6 Months Key to Predicting HIV Prognosis

Making Predictions After Start of HIV Treatment May Be Better

Medically Reviewed by Michael W. Smith, MD on August 28, 2003
From the WebMD Archives

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 treatment.

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 later.

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 treatment.

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 of treatment.

"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 regimens."

Faster Progression

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 were:

  • Age over 50 years
  • HIV infection through injection drug use
  • AIDS diagnosis before or within six months of the start of HIV treatment

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.

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SOURCE: The Lancet, Aug. 30, 2003.

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