Post-HAART CD4+ Cell Count Best Predictor
Anastos K, Barron Y, Cohen MH, et al. The prognostic importance of changes in CD4+ cell count and HIV-1 RNA level in women after initiating highly active antiretroviral therapy. Ann Intern Med. 2004;140:256-264. The Women's Interagency HIV Study is a 5-center, prospective cohort study of women with HIV infection. The present study was performed to determine the prognostic value of the CD4+ cell count and HIV viral load for clinical events: a new AIDS-defining diagnosis or death. The analysis included 1132 participants with a median follow-up of 3.9 years. During the follow-up period, there were 135 patients who died, including 60 who died from AIDS-related complications. There were 276 who developed a new AIDS-defining illness. Surprisingly, the CD4+ cell count and viral load before highly active antiretroviral therapy (HAART) were not very important predictors. Most important was the post-HAART CD4+ cell count. These results are summarized in Table 1 .
Comment: This study shows that response to HAART is the most important predictor of outcome. This conclusion is identical to that of the large study reported by Egger and others that combined 13 cohort studies to determine the most important prognostic factors for death or an AIDS-defining diagnosis. This analysis of 9323 patients showed that the best indicator was the response to HAART at 6 months. These studies diminish the importance of defining start rules on the basis of CD4+ cell count and/or the HIV viral load. It is reassuring that a delay to late-stage disease does not preclude response to HAART. Nevertheless, it is unlikely that anyone will change the guidelines to start therapy on the basis of these results.
Medscape HIV/AIDS. 2004;10(1) © 2004 Medscape
Cite this: HIV/AIDS: March 15, 2004 - Medscape - Mar 16, 2004.