Overall trends in CD4 counts and plasma viremia in an urban clinic since the introduction of highly active antiretroviral therapies

Abstract

Objective. To assess whether the benefit of highly active antiretroviral therapies (HAART) is continuing, a longitudinal retrospective study of CD4 counts and viral load (VL) in a large group of human immunodeficiency virus (HIV)-infected subjects was undertaken in Madrid. Methods. Consecutive plasma VL values and CD4+ T-lymphocyte counts were collected during a 3-month period yearly from 1996 to 2000 in one HIV/acquired immune deficiency syndrome (AIDS) reference institution, where currently around 1500 HIV-infected individuals are on regular follow-up. Results. VL values and CD4+ counts were collected at each time-point from an average of 375 and 391 patients, respectively. The proportion of subjects receiving HAART among those on any kind of antiretroviral treatment increased between 1996 (61%) and 2000 (95.1%) (P < 0.01). The number of subjects with undetectable VL (<500 HIV-RNA copies/mL) increased from 12% in 1996 to 64% in 2000 (P < 0.01). Accordingly, the proportion of individuals with CD4+ counts >500 cells/μL increased from 16% in 1997 to 54% in 2000 (P < 0.01). Notably, the number of subjects with VL values >10 000 copies/mL has declined over time, and currently represents only 17% of the population. Despite this favorable trend, the proportion of subjects with low CD4+ counts (<200 cells/μL) seems to have reached a plateau, in the range of 10%. Conclusions. A dramatic virological and immunological benefit has followed the introduction of HAART in HIV-infected patients since 1996. This favorable trend seems to be maintained over time, despite the negative impact of drug-related toxicity and/or adherence issues. However, a subgroup of subjects seems to persist with low CD4 counts despite having good virological control. They should be managed with alternative treatment strategies, including immune stimulatory agents.