Effect of Antiretroviral Therapy on Viral Load, CD4 Cell Count, and Progression to AIDS in a Community HIV-Infected Cohort [P Erb, et al. Arch Intern Med 2000;160:1134]: This analysis from the Swiss HIV Cohort was designed to determine retrospectively the effect of different antiretroviral regimens on viral load, CD4 count, and rates of progression to HIV. Three different types of treatment regimen were analyzed: nucleoside monotherapy, nucleoside combination treatment, and HAART. The expected results were found: use of HAART resulted in superior outcomes in terms of virologic response, CD4 cell count response, and rates of progression to AIDS. The authors noted that their results with achieving virologic success with HAART, although superior to the alternative treatment strategies, was inferior to the results generally shown in clinical trials. The details of the results are shown in the following table:

Outcome With Antiretroviral Therapy - Swiss Cohort Study
	NRTI monotherapy n = 57	NRTI combination therapy n = 479	HAART n = 219
Baseline (median)     VL (log10)     CD4 (/mm3)	5.0 120	4.6 281	5.1 110
Virologic outcome     <400 c/mL	12%	41%	63%
CD4 count     >50% increase	35%	34%	60%
VL <500 c/mL and     CD4 increase >50%	7.0%	22.3%	53%
Progression to AIDS	13.6%	4.7%	3.9%

Comment: The results here were quite predictable. The use of nucleoside monotherapy may be puzzling, but there were relatively few patients in this cohort, which reflects the early phase of the study that began in 1995. The superior results with HAART are particularly striking when noting that this group had far more advanced disease at baseline. The authors try to address the issue of "hit hard and hit early" but acknowledge that their study does not provide relevant information since HIV "was hit rather late by today's standards." posted 5/25/2000