Important note: Information in this article was accurate in June 2000. The state of the art may have changed since the publication date.AIDSWEEKLY Plus; Monday, June 26, 2000
Prepared by AIDS Weekly editors from staff and other reports
NewsRx -- Predictors of virological success or ensuing failure for HIV-1 patients undergoing highly active antiretroviral therapy (HAART) were evaluated in a study conducted in Europe.
"Predictors of virological response to HAART have never been systematically evaluated in a large, continental, multicenter cohort of unselected human immunodeficiency virus (HIV) infected people," stated R. Paredes and colleagues, Hospital University Germans Trias & Pujol, Retrovirology Laboratory IrsiCaixa, Spain. "Our objectives were to determine the factors related to achieving and maintaining undetectable plasma HIV-1 RNA levels among HIV-1 infected patients first starting protease inhibitor- or nonnucleoside retrotranscriptase inhibitor-containing HAART in Europe."
Paredes et al. published the results of their study in Archives of Internal Medicine ("Predictors of virological success and ensuing failure in HIV-positive patients starting highly active antiretroviral therapy in Europe - Results from the EuroSIDA Study," Arch Intern Med 2000 Apr 24;160(8):1123-32.
The study was designed around a prospective multicenter cohort. It incorporated 52 clinical centers in 17 European countries from August 1996 to April 1999. This group of centers are part of the EuroSIDA Study Group. The researchers recruited 1,469 HIV+ patients from an unselected cohort of more than 7,300 HIV+ patients. The patients were just starting HAART.
"Most patients (80%) achieved plasma HIV-1 RNA levels of <500 copies/mL during follow-up (60.4% at six months from the onset of HAART). Patients with higher baseline HIV-1 RNA levels (relative hazard [RH], 0.76 per log higher; 95% confidence interval [CI], 0.69-0.84; P<.001) and those taking saquinavir mesylate hard gel as a single protease inhibitor (RH, 0.62; 95% CI, 0.47-0.82; P<.001) were less likely to reach undetectable HIV-1 RNA levels. Conversely, higher CD4+ lymphocyte counts (RH per 50% higher, 1.09; 95% CI, 1.02-1.16; P=.008) and the initiation of three or more new antiretroviral drugs (RH, 1.29; 95% CI, 1.03-1.61; P=.02) were independent predictors of higher success."
Even though initial success was achieved in treated patients, more than one third of all patients experienced rebounded levels of HIV-1 RNA during follow-up (24% at six months), reported Paredes et al. Data showed that antiretroviral-naive patients (RH, 0.50; 95% CI, 0.29-0.87, P=.01), older patients (RH, 0.86 per year older; 95% CI, 0.75-0.99; P=.04), and those starting a protease inhibitor other than saquinavir hard gel (RH, 0.66; 95% CI, 0.44-0.98; P=.04) were not as likely to experience virological failure.
Conversely, those patients with higher baseline HIV-1 RNA level (RH, 1.18 per log higher; 95% CI, 0.99-1.40; P=.06) and those that took longer to achieve virological success (RH per 12 months, 1.53; 95% CI, 0.99-2.38; P=.06) demonstrated a marginally significant, but predictable likelihood of ensuing virological failure.
"HAART is associated with a favorable virological response if started when the baseline HIV-1 RNA level is low, if at least two new nucleoside retrotranscriptase inhibitors are added, and if standard doses of saquinavir hard gel capsule are avoided as a single protease inhibitor," Paredes et al. concluded.
"Older patients are more likely to achieve virological success. Thereafter, the higher durability of virological response is predicted by an antiretroviral naive status and by the use of specific regimens. Lower baseline HIV-1 RNA levels and rapid maximal viral suppression seem to be other important factors in the durability of virological response."
The corresponding author for this report is R. Paredes, Hospital University Germans Trias & Pujol, Retrovirology Laboratory IrsiCaixa, Crta Del Canyet S-N, Badalona 08916, Catalonia, Spain.
A search of the www.NewsRx.com online database using the term "HAART" generated 257 articles.
Key points reported in this study are:
This article was prepared by AIDS Weekly editors from staff and other reports.
000626
AW000607
Copyright © 2000 - Charles Henderson, Publisher. All rights Reserved. Permission to reproduce granted to AEGIS by Charles W. Henderson. Authorization to reproduce for personal use granted granted by C. W. Henderson, Publisher, provided that the fee of US$4.50 per copy, per page is paid directly to the Copyright Clearance Center, 27 Congress Street, Salem, Massachusetts 01970, USA. Published by Charles Henderson, Publisher. Editorial & Publishing Office: P.O. Box 5528, Atlanta, GA 30307-0528 / Telephone: (800) 633-4931; Subscription Office: P.O. Box 830409, Birmingham, AL 35283-0409 / FAX: (205) 995-1588 http://www.newsrx.net
AEGiS is made possible through unrestricted grants from Boehringer Ingelheim, iMetrikus, Inc., John M. Lloyd Foundation, the National Library of Medicine, and donations from users like you. Always watch for outdated information. This article first appeared in 2000. This material is designed to support, not replace, the relationship that exists between you and your doctor.
AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.
Copyright ©1990, 2000. AEGiS. All materials appearing on AEGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of AEGiS, or the party credited as the provider of the content.