( n individual patient's CD4 cell loss ra...)AIDS study challenges conventional treatment guidelines for HIV patients

n individual patient's CD4 cell loss rate can be explained by his or her presenting viral load. Moreover, the results were remarkably similar when the analyses were reproduced separately in each of the two cohorts, and changed only minimally when the investigators considered the possible effect of errors in the measurement of the CD4 cell count and the HIV viral load.

These results represent a shift in the paradigm that the rate of CD4 cell loss in a given HIV-infected individual can be accurately predicted by his or her viral load. Predicting disease progression is crucial in the treatment of HIV-positive people, such as in making the decision as to when it is best for starting antiretroviral therapy. Current treatment guidelines, while diminishing its importance, continue to include HIV viral load as one element in making decisions regarding when to begin antiretroviral therapy. Antiretroviral therapy, also known as HAART, is credited with saving millions of lives. However, potent side effects and issues of drug resistance, often cause doctors and patients to defer starting the medications, until it becomes medically necessary.

In addition to the clinical ramifications, the findings suggest that HIV-associated CD4 depletion cannot be thought of as a mere consequence of the amount of virus circulating in the blood. Instead, the findings suggest rather more complex scenarios of disease progression, and hint at indirect processes though which HIV can induce damage to the immune system, which cannot be adequately captured by measuring HIV levels in the blood.
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Source:University Hospitals of Cleveland

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