AIDS: between 6 and 18 months after starting treatment, predictive of the patient's condition over several years

The period between 6 and 18 months after initiation of anti-HIV treatment is a good prognostic factor for the patient's condition over several years, according to a study published in "Clinical Infectious Diseases".

Several studies have already examined the predictive value of virologic response during the first six months of highly active antiretroviral therapy (HAART). But Nicolai Lohse, University Hospital of Odense (Denmark), and his colleagues believe that the prognostic nature of this period, often punctuated by episodes of toxicity and changes in antiretroviral regimen is limited.

The researchers conducted a study of 2046 Danish patients to determine if recorded during the period between six months and 18 months after initiation of HAART viral load possible to better predict the patient's condition after 90 months of treatment .

They divided the patients into three groups according to viral load measurements recorded during the period of one year.

The first group consisted of 1173 patients with persistently undetectable viral load (below 400 copies / ml) during the year, while that of the 327 patients in group 3 had never been below the detection limit. Group 2 included 546 patients having the other two types of results.

After 90 months of treatment, almost all patients in the first group (96%) had an undetectable viral load, against 83% in group 2 and 57% in group 3.

Compared with patients in the first group (92.7% of survivors), group 2 were 2.63 times more likely to die, while those in Group 3 endured a risk multiplied by 4.53. The latter died more frequently following a progression to AIDS disease (43%) than group 1 (18%).

In the end, 89% of patients in group 1 were still alive and had an undetectable viral load after 90 months of treatment, against 71% in group 2 and 43% in group 3.

The researchers also highlighted the negative effect of treatment interruptions. The 92 patients in group 2 having stopped at least two weeks during the first 18 months had a chance of survival 3.48 times lower than that of people more observant of the same group, and even 1.49 times lower than that of patients Group 3.

"A therapeutic abortion during the first 18 months of HAART is a good predictor of mortality in patients who achieve a partial viral suppression," said the authors.

"The achievement of an undetectable viral load is the primary goal of treatment in routine clinical practice," they concluded