Revista de SIDA e investigación clínica

Immunological and Virological Outcomes at 5 Years in HIV Infected Adults Who Start HAART at a CD4 Cell Count of Less Than 200 in Barbados

Abstract

Alok Kumar, Krishna R Kilaru and Timothy C Roach

Objective: To assess the immunologic and virological response after 5 years of highly active antiretroviral therapy (HAART) in treatment naive HIV-1 infected adults presenting late in the course of their disease.

Design: Prospective long term observational study. The response to HAART is described in HIV-1 infected ARV naïve adults initiating treatment at CD4+ cell counts < 200 during June 2005 through December 2005 in Barbados, West Indies. Baseline values as well as 5 years post-HAART values for CD4+ cell counts and viral load were recorded for the cohort.

Results: 50 ARV naïve HIV-1 infected adults initiated treatment when their CD4+ cell count was, 200. Most received Combivir plus Nevirapine or Efavirenz. At the baseline, their median CD4+count was 36 cells/μL (IQ Range:15-82) and their median viral load was at 75,000 (4.87 log10) with an IQ Range of 52,700-226,000. After 5 years of therapy, the median increase in the CD4+ cell count was 122 cell/μL (IQ Range, 45-185). Twenty three (46%) patients had achieved CD4+ cell counts of >200 cells/μL. 36 (72%) patients had an undetectable viral load (<50 copies/mL). The median decline in viral load at 5 years of therapy was 74,950 (4.87 log10) copies/mL with an IQ Range of 52,700 -226,000.

Conclusion: In this relatively small cohort of treatment naïve patients presenting late in the course of HIV disease, there was good immunological and virological response after 5 years of initiating HAART irrespective of their baseline CD4+ counts and viral load, age or gender.