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Viral load reduction, no matter how
small, can have immunological benefits for people living with HIV who have
experienced triple-class treatment failure, according to a recent study from
the Collaboration of Observational HIV Epidemiological Research Europe
(COHERE).
Despite the various antiretroviral
classes currently available for people living with HIV, many individuals still
develop drug resistance, which leads to fewer options. Often, for patients with
multi-class resistance, clinicians take actions with the primary goal of
increasing CD4+ cell count (in order to reduce the risk of serious illness),
rather than take actions with the primary goal of suppressing HIV viral load.
To explore the wisdom of this
approach, researchers analyzed viral load data on 2,424 people who had started
antiretroviral therapy from 1998 onward and who had experienced treatment
failure with at least three classes of drugs.
In particular, they looked at
treatment failure involving the three main antiretroviral classes: nucleoside
reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase
inhibitors (NNRTIs) and ritonavir (Norvir)-boosted protease inhibitors (PI/r).
AIDSMAP.COM Reported:
Most of the patients (67%) were men
and their median age was 40 years. The patients had been taking antiretroviral
therapy for a median of four years before triple-class failure was diagnosed.
Median viral load at this time was 4 log10 copies/mL, whereas median CD4 cell
count was 270 cells/mm3.
The investigators' initial analysis
showed a strong linear association between CD4 cell count and viral load after
treatment failure. CD4 cell count was 48 cells/mm3 lower per 1 log10 increase
in viral load.
Only a small minority of people were
treated with newer classes of antiretrovirals such as fusion inhibitors (7%),
integrase inhibitors (9%) and CCR5 inhibitors (1%).
While the goal of any HIV
antiretroviral regimen is to achieve an undetectable viral load, this study
suggests that any degree of viral suppression can benefit a patient's CD4+ cell
count and lower his or her risk of clinical disease.
"It makes sense that the lower
the viral load (at least on treatment, and even with non-suppressive regimens),
that the greater the benefit to CD4s (and immune function)," said Benjamin
Young, M.D., Ph.D., Chief Medical Officer of the International Association of
Providers in AIDS Care. (Dr. Young was not an investigator in this study.)
As for the clinical implications,
the study authors concluded the following, according to aidsmap.com:
While in those with high CD4 count
it may be possible to wait until new active drugs are available, for those with
low CD4 count it is important to use the regimen most likely to achieve maximal
viral suppression. We found that the current viral load is closely linked to
the CD4 count, suggesting a rapid benefit of viral load suppression, so in an
individual who is not fully adherent, any increase in adherence is likely to
provide immediate benefits in terms of reduced risk of clinical disease.
The Friends of AIDS Foundation is
dedicated to enhancing the quality of life for HIV positive individuals and
empowering people to make healthy choices to prevent the spread of the HIV
virus. To learn more about The Friends of AIDS Foundation, please visit: http://www.friendsofaids.org.
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