Clinical Progression of HIV Infection According to the Viral Response During the First Year of Antiretroviral Treatment [Thiebaut R, et al. AIDS 2000; 14: 971]: The authors report the results of observations of a prospective cohort of HIV-infected patients receiving antiretroviral therapy. Of 773 participants followed for a median of 27 months, 62 had a "clinical event" (48 patients had 53 AIDS-defining conditions, and there were 14 deaths). The major predictor of poor clinical outcome was poor virologic response with a viral load >5,000 copies/mL. There was no significant difference in outcome for those with a viral load of <500 copies/mL compared to those with HIV RNA levels of 500 - 5,000 copies/mL. The authors also found that a viral load reduction of <0.5 log₁₀ by four weeks was highly predictive of subsequent virologic failure.
Comment: This is another report that supports the importance of virologic control and the correlation between this outcome and clinical events. The authors also caution that the failure to reduce a viral load by 0.5 log₁₀ at one month predicts long-term virologic failure and that patients with viral loads of 500 - 5,000 may be managed by "deferral of a change in drug regimen according to the patient's history and therapeutic options." posted 7/19/2000