title: Clinical progression and virological failure on highly active antiretroviral therapy in HIV-1 patients: a prospective cohort study. Swiss HIV Cohort Study.
abstract: BACKGROUND
  The efficacy of highly active antiretroviral therapy (HAART) in suppression of HIV-1 is well documented. We investigated virological and clinical outcomes of HAART in routine practice.
  
  
  METHODS
  We analysed prospective data from the Swiss HIV Cohort Study on suppression of viral load and progression to AIDS or death in 2674 outpatients (median age 36 years, 27.3% women) who started HAART in 1995-98. Viral rebound was defined as two consecutive HIV-1-RNA measurements of more than 400 copies/mL. We analysed separately outcomes in patients with a history of antiretroviral treatment and in treatment-naïve patients.
  
  
  RESULTS
  An estimated 90.7% of treatment-naïve patients reached undetectable viral load (<400 copies/mL) by 12 months. Among pretreated patients, estimates ranged from 70.3% treated with one new drug to 78.7% on three new drugs. 2 years after reaching undetectable concentrations, an estimated 20.1% of treatment-naïve patients and 35.7-40.1% of pretreated patients had viral rebound. At 30 months, an estimated 6.6% (95% CI 4.6-8.6) of patients who had maintained undetectable concentrations, 9.0% (5.5-12.5) who had viral rebound, and 20.1% (15.3-24.9) who had never reached undetectable concentrations developed AIDS or died. Compared with patients who maintained undetectable viral load, the adjusted relative hazard of AIDS or death was 1.00 (0.66-1.55) for patients with viral rebound, and 2.40 (1.72-3.33) for patients who failed to reach undetectable concentrations.
  
  
  CONCLUSIONS
  The rate of virological failure of HAART was high among these patients, but the probability of clinical progression was low even in patients with viral rebound.
authors: Division of Infectious Diseases and Hospital Epidemiology, University of Zurich, Switzerland. infled@usz.unizh.ch
authors: B
authors: B
authors: Ledergerber
authors: M
authors: M
authors: Egger
authors: M
authors: M
authors: Opravil
authors: A
authors: A
authors: Telenti
authors: B
authors: B
authors: Hirschel
authors: M
authors: M
authors: Battegay
authors: P
authors: P
authors: Vernazza
authors: P
authors: P
authors: Sudre
authors: M
authors: M
authors: Flepp
authors: H
authors: H
authors: Furrer
authors: P
authors: P
authors: Francioli
authors: R
authors: R
authors: Weber
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count / Q000187:drug effects; D018562:Disease Transmission, Infectious; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000635:transmission; D015497:HIV-1 / Q000302:isolation & purification; D006801:Humans; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D011336:Probability; D011446:Prospective Studies; D012367:RNA, Viral / Q000302:isolation & purification; D013557:Switzerland; D017211:Treatment Failure; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents; D012367:RNA, Viral