Combination antiretroviral therapy beneficial in virologic failure

Even when HIV-infected patients have profound immunosuppression and extensive viral resistance, combination antiretroviral therapy (cART) still provides benefits over therapy interruption, according to a report in Clinical Infectious Diseases.  Dr. Kousignian and colleagues in the Clinical Epidemiology Group of the French Hospital Database on HIV compared the rate of clinical progression in patients with a CD4 cell count below 200 cells and with either detectable or undetectable viral load who either continued cART or interrupted cART.  They found that the rate of AIDS-defining events (ADEs) was 14.5 cases per 100 patient-years among patients who continued cART compared with 18.5 cases per 100 patient-years among patients who had an interruption of cART. Furthermore, within each group, the rates for new ADEs were higher in patients with CD4 cell counts below 50 cells than in the 50-200.   The report also indicates that in both groups, ADE rates were significantly higher in patients with baseline viral loads above 30,000 copies/mL than in patients with lower baseline viral loads.   The overall risks of a new ADE were 22% and 62% lower in patients with detectable viral load and in patients with undetectable viral load on cART, respectively, than in patients with cART interruption. Thus for HIV patients maintaining a failing regimen is preferable to interrupting it because cART still reduces the risk of a new AIDS-defining event, and still protects against apparition of AIDS opportunistic infection.  In further studies it would be useful to evaluate the different regimens in these patients, including single-drug versus combination therapy, and combinations based on nucleoside reverse transcriptase inhibitors versus nonnucleoside reverse transcriptase inhibitors or protease inhibitors.