Patients with advanced disease studied

French investigators have analyzed the degree of correlation between the evolution of CD4 counts and viral load in patients in advanced stages of immune suppression (CD4 counts <200/ml). D. Vittecoq, MD, and colleagues at the Hopital Paul Brousse in Villejuif, France, evaluated CD4 and viral load counts as well as clinical status every three months for 15 months in 90 patients on triple therapy that included indinavir (Crixivan).

Nine patients had never received antiretrovirals; the remaining 81 patients had a mean duration of exposure to nucleosides of 24 months. Mean CD4 counts and viral loads increased during the study from 133/ml and 4.2 at month three, respectively, to 196/ml and 15 at month 15, respectively. No patients died during the study, and only four developed an AIDS-related event.

"After a long period of evaluation . . . the clinical benefit of indinavir in association to nucleoside is obvious since only 4.4% of patients developed an AIDS-related event," the researchers conclude. They add, though, that "such benefit in this very advanced population of HIV-infected patients is more closely related to the CD4 slope . . . than to the viral load slope."