title: Virological and immunological response to HAART therapy in a community-based cohort of HIV-1-positive individuals.
abstract: OBJECTIVE
  To determine virological and immunological response to highly active antiretroviral therapy (HAART) and to investigate factors influencing response in a community-based setting.
  
  
  METHODS
  Plasma HIV RNA levels and CD4 cell counts were studied in 168 unselected individuals starting HAART including indinavir or ritonavir or hard-gel saquinavir-containing regimens.
  
  
  RESULTS
  Overall, 60% of the patients reduced their HIV RNA to below 500 Eq/mL, but half of them experienced a subsequent virologic rebound. Patients with higher baseline HIV RNA, higher baseline CD4 cell count, and simultaneous initiation of combination therapy and patients on indinavir or ritonavir regimen were more likely to have virologic response within 6 months since HAART initiation. Patients with lower baseline CD4 cell count and with lower rates of viral clearance had a higher probability of a subsequent virologic rebound. Forty percent of the patients had increased their CD4 cell counts by more than 100 cells/microL (immunologic response). The probability of immunologic response was independent of baseline HIV RNA levels and CD4 cell count; however, the more complete the virologic suppression, the higher the probability of immunologic response. Thirty percent of the patients had discordance between virologic and immunologic responses.
  
  
  CONCLUSIONS
  The rate of virologic failure in this unselected group of patients was higher than that observed in randomized clinical trials, but only a minority (11%) of the patients were treatment naïve. Starting combination therapy simultaneously and initiating antiretroviral therapy before advanced HIV disease has developed predict virologic response, whereas the magnitude of viral suppression predicts mid to long immunological response.
authors.affiliation: Department of Hygiene and Epidemiology, Athens University Medical School, Athens, Greece.
authors.forename: G
authors.initials: G
authors.lastname: Touloumi
authors.forename: V
authors.initials: V
authors.lastname: Paparizos
authors.forename: H
authors.initials: H
authors.lastname: Sambatakou
authors.forename: O
authors.initials: O
authors.lastname: Katsarou
authors.forename: G
authors.initials: G
authors.lastname: Chrysos
authors.forename: T
authors.initials: T
authors.lastname: Kordossis
authors.forename: A
authors.initials: A
authors.lastname: Antoniadou
authors.forename: H
authors.initials: H
authors.lastname: Hatzitheodorou
authors.forename: N
authors.initials: N
authors.lastname: Stavrianeas
authors.forename: P
authors.initials: P
authors.lastname: Gargalianos
authors.forename: A
authors.initials: A
authors.lastname: Karafoulidou
authors.forename: M
authors.initials: M
authors.lastname: Lazanas
authors.forename: H
authors.initials: H
authors.lastname: Giamarelou
authors.forename: A
authors.initials: A
authors.lastname: Hatzakis
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology* / Q000821:virology; D015497:HIV-1 / Q000302:isolation & purification* / Q000502:physiology; D006801:Humans; D008297:Male; D012367:RNA, Viral / Q000097:blood*
chemical_list: D012367:RNA, Viral