Predictors of Virological Success and Ensuing Failure in HIV-Positive Patients Starting Highly Active Antiretroviral Therapy in Europe: Results From the EuroSIDA Study [R Paredes, et al. Arch Intern Med 2000;160:1323]: EuroSIDA is a consortium of 17 European countries with a cohort of 7,331 patients with HIV infection. The current study is a retrospective analysis to determine factors associated with virologic success (defined as a viral load <500 copies/mL) in 1,469 unselected patients who initiated HAART therapy. The results showed that 80% of patients given HAART had viral loads <500 copies/mL at some time during a follow-up period of approximately six months. Virologic success was independently predicted by low baseline plasma HIV RNA level, high baseline CD4 cell counts, and initiation of three or more antiretroviral drugs. The results with these three factors were statistically significantly better by multivariate analysis.
Comment: There are probably no surprises here except that the overall result seems to be better than those achieved in many U.S. - based clinics, although it should be noted that the threshold to define virologic success was 500 copies/mL, only 24% of the cohort had IV drug use as a risk factor, and the patients were PI naïve at baseline. The CD4 cell count results are possibly relevant to the current debate regarding use of a CD4 cell count threshold to determine when to initiate treatment. Other findings include the following: the median time required to reach undetectable viral loads was four months; at six months, 24% of the patients had viral rebound after achieving undetectable levels; and the median time to virologic failure after achieving undetectable levels was 19 months. posted 5/25/2000