HIV prognosis best determined after six months of treatment

A study published in the August 30 edition of The Lancet shows that evaluating an HIV-positive adult's T-cell count and HIV viral load after six months of anti-HIV drug therapy is the best gauge of how quickly the disease may progress. Baseline numbers are poor prognosis indicators, according to the study. Researchers in Switzerland examined data from 13 studies involving more than 9,300 HIV-positive people starting their first anti-HIV drug regimen. A total of 374 patients developed AIDS, and 152 died. After six months of antiretroviral drug treatment, patients with T-cell counts below 25 were shown to be more likely to develop AIDS or die, while those with T-cell counts over 350 were the least likely to experience disease progression. Patients with viral loads over 100,000 also were the most likely to develop AIDS or die, with those posting counts below 500 the least likely to experience disease progression. The risk of death after 3.5 years of treatment for patients with both low T-cell counts and high viral loads after the first six months of drug therapy was 83.1%, compared with just 2.4% for patients with high T-cell counts and low viral loads after six months of treatment. "Our results have important implications for management of patients who have not previously had antiretroviral treatment and who start potent therapy," the authors wrote, adding that the findings "should inform guidelines on when to modify [highly active antiretroviral therapy]."