HIV/AIDS: March 15, 2004

John Bartlett, MD


March 15, 2004

In This Article

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[1] 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.