The Relation of Virologic and Immunologic Markers to Clinical Outcomes after Nucleoside Therapy in HIV-Infected Adults with 200 to 500 CD4 Cells per Cubic Millimeter

We studied measures of human immunodeficiency virus replication, the viral phenotype, and immune function and the relation of changes in these indicators to clinical outcomes in a subgroup of patients in a controlled trial of early antiretroviral treatment for HIV, the acquired immunodeficiency syndrome Clinical Trials Group Study 175

David A. Katzenstein

2002

Scholarcy highlights

  • The acquired immunodeficiency syndrome Clinical Trials Group Study 175 provides direct evidence, in the clinical report elsewhere in this issue of the Journal, of the clinical and immunologic benefits of the treatment of human immunodeficiency virus infection with didanosine, zidovudine plus didanosine, and zidovudine plus zalcitabine, as compared with zidovudine monotherapy
  • We studied measures of human immunodeficiency virus replication, the viral phenotype, and immune function and the relation of changes in these indicators to clinical outcomes in a subgroup of patients in a controlled trial of early antiretroviral treatment for HIV, the AIDS Clinical Trials Group Study 175
  • Multivariate proportional-hazards models showed that higher base-line concentrations of plasma HIV RNA, less suppression of plasma HIV RNA by treatment, and the presence of the syncytium-inducing phenotype were significantly associated with an increased risk of progression to the acquired immunodeficiency syndrome and death
  • The changes in the plasma concentration of HIV RNA predict the changes in CD4 cell counts and survival after treatment with reverse-transcriptase inhibitors
  • Further analyses indicate that the associations of disease progression with base-line plasma HIV RNA concentrations, CD4 cell counts, and the viral phenotype were not significantly different between subjects who did and subjects who did not have a history of antiretroviral treatment, nor did they differ among the four treatment groups
  • Our study found a significant association between a reduction in the plasma HIV RNA concentration after the initiation of therapy with antiretroviral drugs and a reduction in the risk of AIDS and death, but there was less evidence that changes in the CD4 cell count in response to drug therapy provided a useful indication of the risk of clinical progression
  • The changes in the plasma concentration of human immunodeficiency virus RNA predict the changes in CD4 cell counts and survival after treatment with reverse-transcriptase inhibitors

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