HAART evaluated in the newly diagnosed

Early and aggressive highly active antiretroviral therapy (HAART) in patients newly infected with HIV appears to be highly effective, according to investigators from the University of British Columbia in Vancouver.

Infectious diseases physician Valentina C. Montessori, MD, FRCP, and colleagues enrolled 59 patients in a prospective cohort study from March 1995 until June 1997. Forty-eight of the patients were male; 22 had had sex with other men, 25 were injection drug users (IDUs), and six were heterosexual. Of the 11 female patients, eight were IDUs and three were heterosexuals.

Patients were seen for the first time by physicians a median of 61 days after their estimated date of HIV infection. The average number of symptoms patients had was six, with the most common symptoms being fever (66%), lethargy (59%), and pharyngitis (57%).

Although 11 patients refused treatment, the remaining 48 patients received two nucleoside analogues before June 1996 and two nucleoside analogues and a protease inhibitor after June 1996. The untreated patients’ viral load and CD4 counts also were measured throughout the study.

The median baseline plasma viral loads (pVL) in treated and untreated patients were 5.2 and 5.1 log10 copies/mL, respectively. Median baseline CD4 counts were 420 and 500 cells/mm3 among treated and untreated patients, respectively. Fifty patients (85%) returned for follow-up visits, with a median number of follow-up visits of four and a median duration of follow-up of 18 weeks. After 12 weeks, the median decrease in pVL was 1.7 log10 copies/mL in treated patients and 0.5 log10 copies/mL in untreated patients. The median increase in CD4 counts was 190 in treated and 90 in untreated patients.

"We have been able to assemble a cohort of newly infected individuals," Montessori reports. "Despite the large number of IDUs in our cohort, we were able to initiate treatment and maintain regular follow-up in the majority of patients."