title: 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/microL 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/microL) 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.
authors.affiliation: Service of Infectious Diseases, Hospital Carlos III, Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: J C
authors.initials: JC
authors.lastname: Martín
authors.forename: V
authors.initials: V
authors.lastname: Soriano
authors.forename: I
authors.initials: I
authors.lastname: Jiménez-Nácher
authors.forename: P
authors.initials: P
authors.lastname: Martínez
authors.forename: J
authors.initials: J
authors.lastname: González-Lahoz
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D004359:Drug Therapy, Combination; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D006801:Humans; D008137:Longitudinal Studies; D012189:Retrospective Studies; D013030:Spain; D016896:Treatment Outcome; D014505:Urban Population / Q000706:statistics & numerical data; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents