When Emilio L, 39, tested HIV positive, he felt like his
world had ended. However, a year-and-a-half later, it
hasn't even meant the end of his reign as neighbourhood
bocce champion, as Emilio has so far managed to escape
progression to full blown AIDS. Since the introduction
of highly active antiretroviral therapy (HAART), the number
of non-progressors like Emilio has increased, but until
now little was known about how HAART affects the various
viral, bacterial, protozoan and other AIDS-defining events
in the early years of treatment. A study in the February
28 issue of the Archives of Internal Medicine that
followed the progress of over 12,000 people has demonstrated
that HAART is successful in lessening the development
of hallmark events in people with AIDS.
"Our study confirms that the use
of HAART has had a dramatic impact on the incidence
of all AIDS events, regardless of their cause," says
Dr Caroline A Sabin, in an earlier interview with Reuters
Health. Dr Sabin, of the Royal Free and University College
Medical School in London, England, was one of the investigators
that collaborated on the research.
But, despite this good news, Dr
Sabin has a word of caution. "Whilst the incidence of
AIDS is very low in those who are receiving HAART, the
decline in incidence of AIDS events with a fungal cause
appears to be less rapid than that of other types of
AIDS patients, and fungal events become relatively more
common with increased time on therapy."
FEAR
OF FUNGAL INFECTIONS
"Our findings suggest that physicians should pay particular
attention to fungal events in individuals receiving
HAART," Dr Sabin told Reuters Health. Dr Sabin's conclusion
is based on her study in which 12,574 patients were
followed. The folks were "antiretroviral-na�ve" when
they began their HAART regimen. The rates of AIDS were
calculated at 0-3, 4-6, 7-12, 13-24, and 25-36 months
after starting the HAART triple enzyme cocktail.
During the almost 23,000 person-years
of followup in the study, there were 928 AIDS events,
of which 25.3% were viral, 24.6% bacterial, 20.7% fungal,
8.1% protozoan and 21.2% due to other agents. The incidence
of any of these events declined significantly from 129.3
per 1,000 person-years in the first three months of
HAART to 13.2 in the third year. The decline was greatest
for the viral events (87.0%) and lowest for fungal events
(54.0%), such that by the third year of HAART treatment,
fungal problems represented 37% of the AIDS events.
However, even the decline in fungal-related
events, let alone viral and bacterial, was greater than
expected, based on changes in the CD4 count and level
of HIV1 genetic material, suggesting "a benefit of HAART
beyond the improvement of these surrogate markers,"
according to the researchers.
Arch Intern Med Feb 28, 2005;165:416-23
For more on HAART see "Dr
Julio Montaner: the force behind Canada's foremost AIDS
research centre"
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