The Pharmaceutical Journal
Vol 277 No 7413 p182
12 August 2006

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AIDS progression remains a problem despite HAART

Virological response after starting highly active antiretroviral therapy (HAART) has improved with each year of its use, according to an analysis of a decade's experience with HAART in Europe and North America, published in The Lancet (2006;368:451) ahead of this month's International AIDS Conference in Toronto.

But this improvement has not seen a corresponding decrease in AIDS progression or mortality, the authors say.

Researchers analysed data from 22,217 patients initiated on the therapy and then followed up in one of 12 cohort studies. The subjects, who had never taken HAART before, were stratified depending on the year that they were initiated on therapy — analyses sought to determine what differences in patient characteristics and response to HAART existed between the calendar years.

Virological response to HAART was greater for patients started on therapy in 2002–03 than for those started in 1995–96 (HIV-1 RNA of 500 copies per ml or less by six months: 83 per cent versus 58 per cent).

On the other hand, compared with patients started on HAART in 1998, the adjusted hazard ratios for progressing to AIDS were 1.07 (CI 0.84–1.36) for those who started in 1995–96 and 1.35 (CI 1.06–1.71) in 2002–03. The figures for death were 0.87 (CI 0.56–1.36) and 0.96 (CI 0.61–1.51), respectively.

The authors say: “The discrepancy between the clear improvement we recorded for virological response and the apparently worsening rates of clinical progression might be related to the change in the demographic characteristics of study participants, with an increasing number of patients from areas with a high incidence of tuberculosis.”

The study shows that the proportion of heterosexual infected patients increased from 20 per cent in 1995–96 to 47 per cent in 2002–03. The proportion of women infected rose from 16 per cent to 32 per cent.

The authors point out that there have been increasing numbers of patients from sub-Saharan Africa, who were more often female, were more likely to have contracted the virus heterosexually, had lower CD4 cell counts at presentation and had greater likelihood of tuberculosis as an AIDS-defining diagnosis.