Increased AIDS defining events despite HAART, according to an international study

The incidence of AIDS defining events has increased since 1999, despite the use of highly active antiretroviral therapy (HAART), according to an international study published in the "Lancet".

This work was conducted by researchers at the ART-CC (Antiretroviral therapy cohort together), an international group working on twelve cohorts, including two French: the hospital database of HIV infection (IHF) and the Aquitaine cohort.

The first results confirm any improvement in terms of virologic response, with 51% more likely to have a viral load less than 500 copies / ml after six months of treatment in 2002/2003 compared to 1998, chosen as year reference.

This phenomenon is particularly marked in patients homosexuals, is the result "of the new generation of treatments, more effective and better tolerated, thus encourage compliance," he told Reuters Health Professor Geneviève Chêne, co-author works Bordeaux in the Aquitaine cohort, and is also responsible for the coordinated "cohorts" of the National Agency for Research on AIDS and Viral Hepatitis (ANRS) action.

"these rather encouraging early results," the researchers observed that the risk of developing an AIDS defining event one year after initiation of treatment shows a steady increase, with greater than 35% in 2002/2003 compared to 1998 risk while the risk of death at one year showed no significant decrease.

A finer analysis of the results shows that the rate of AIDS defining events decreased in 1998 and 1999, then increased.

According to Geneviève Chêne, these results stem from "a change in the profile of patients," now more frequently immigrant and living in poverty.

This statement seems to supported by the increase over time in the proportion of heterosexuals and women in twelve cohorts, but also by the growing role held by tuberculosis in AIDS defining events. The risk of contracting this disease, mostly found in people of sub-Saharan origin, has indeed multiplied by 2.98 between 1998 and 2002/2003.

These changes also coincide with later put under treatment, known to promote the complications factor. Thus, the CD4 count at initiation of HAART increased from 269 cells/mm3 in 1998 to 202 cells/mm3 in 2002/2003.

The resurgence of AIDS defining events resulting "problem detection and access to care, not their quality," concludes Professor Geneviève Chêne, which calls for an awareness of the arrival of new populations at risk .