How quickly an HIV patient's immune system deteriorates may not affect the outcome of the illness, a study has found, and this could help change current guidelines for treatment of the disease.
How quickly an HIV patient's immune system deteriorates may not affect the outcome of the illness, a study has found, and this could help change current guidelines for treatment of the disease.
There is no cure for the human immunodeficiency virus (HIV) that causes AIDS, but combinations of drugs can keep the virus from replicating and damaging the immune system. Doctors and health care practitioners normally do not start treatment until there is some evidence of damage to this system, measured by counting the number of immune cells, called CD4 T-cells. Current guidelines suggest starting HIV treatment, even in symptom free HIV-positive patients, when CD4 numbers drop below 350 cells per microlitre of blood.
CD4 cell count is therefore a strong predictor of the subsequent risk of AIDS or death in HIV-infected patients initiating combination antiretroviral therapy (cART). It is not known whether the rate of CD4 cell decline prior to therapy is related to prognosis and should, therefore, influence the decision on when to initiate cART. To investigate this, researchers examined the records of 2,820 HIV patients from Australia, Canada and Europe with varying rates of CD4 declines.
The researchers found that there was no association between pre-cART CD4 cell decline and survival. In another group of 1,731 AIDS-free patients with >350 CD4 cells/µl at the time of initiating treatment, the rate of CD4 cell decline was also not significantly associated with progression to AIDS or death. Furthermore, the findings showed that the rate of CD4 cell decline in individual patients is highly variable over time. Consequently, a rate measured at one time cannot be used to reliably predict a patient's future CD4 cell count.
This indicates that the current rate of CD4 cell decline is neither a strong predictor of whether a person is progressing to AIDS , nor does it predict future CD4 cell decline. The researchers recommend that knowledge of the current CD4 cell count is sufficient when deciding whether to initiate cART in asymptomatic patients as the knowledge of the rate of CD4 cell count decline will not improve the prediction of clinical outcome in HIV-positive patients with a CD4 cell count above 350 cells/µl.
There is no cure for the human immunodeficiency virus (HIV) that causes AIDS, but combinations of drugs can keep the virus from replicating and damaging the immune system. Doctors and health care practitioners normally do not start treatment until there is some evidence of damage to this system, measured by counting the number of immune cells, called CD4 T-cells. Current guidelines suggest starting HIV treatment, even in symptom free HIV-positive patients, when CD4 numbers drop below 350 cells per microlitre of blood.
CD4 cell count is therefore a strong predictor of the subsequent risk of AIDS or death in HIV-infected patients initiating combination antiretroviral therapy (cART). It is not known whether the rate of CD4 cell decline prior to therapy is related to prognosis and should, therefore, influence the decision on when to initiate cART. To investigate this, researchers examined the records of 2,820 HIV patients from Australia, Canada and Europe with varying rates of CD4 declines.
The researchers found that there was no association between pre-cART CD4 cell decline and survival. In another group of 1,731 AIDS-free patients with >350 CD4 cells/µl at the time of initiating treatment, the rate of CD4 cell decline was also not significantly associated with progression to AIDS or death. Furthermore, the findings showed that the rate of CD4 cell decline in individual patients is highly variable over time. Consequently, a rate measured at one time cannot be used to reliably predict a patient's future CD4 cell count.
This indicates that the current rate of CD4 cell decline is neither a strong predictor of whether a person is progressing to AIDS , nor does it predict future CD4 cell decline. The researchers recommend that knowledge of the current CD4 cell count is sufficient when deciding whether to initiate cART in asymptomatic patients as the knowledge of the rate of CD4 cell count decline will not improve the prediction of clinical outcome in HIV-positive patients with a CD4 cell count above 350 cells/µl.
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