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Viral Blips May Affect CD4 Response to HAART
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"Very low levels of plasma HIV-1 viraemia in subjects with sustained suppression of viraemia <50 copies/ml can influence the recovery of CD4 cell counts after initiating HAART promoting the occurrence of transient viraemic episodes"
Note from Jules Levin: these study results suggest that the CD4 response to HAART may be affected by the potency of the HAART regimen. A potent HAART regimen may be more effective in eliciting greater increases & more durable increases in CD4 count. The 5-year Kaletra followup studies show impressive durable increases in CD4 counts even for patients with <100 CD4 counts at baseline.
ABSTRACT 63
Antiviral Therapy 2004; 9:S72.
AG Marcelin1, V Martinez2, JP Morini2,
J Deleuze2, A Krivine2, I Gorin2, L Perrin3,
G Peytavin4, S Yerly3, N Dupin2 and V Calvez1
1 Pitié-Salpêtrière Hospital, Paris, France; 2 Tarnier-Cochin Hospital Paris, France; 3 Bichat-Claude Bernard, Paris, France; and 4 University Hospital, Geneva, Switzerland
BACKGROUND: It has been shown that most of patients on potent antiretroviral therapy with RNA plasma HIV-1 suppressed to less than 50 copies/ml have persistent viraemia at very low levels when measuredwith highly sensitive methods. Even among patients with complete virological response (<50 copies/ml) the kinetic of CD4 cell count recovery canbe very variable and can be influenced by some factors, such as the age of the patients. The impact of persistent residual viraemia below 50 copies/ml on the evolution of CD4 cell count under antiretroviral therapy has notbeen investigated.
METHODS: We studied 43 patients treated by NRTI plus NNRTI therapy with stable suppression of plasma viraemia (<50 copies/ml) for at least 18 months. We compared plasma HIV-1 RNA levels from patients with transient viraemia or blip (one HIV-1 RNA >50 copies/ml with a subsequent value <50 copies/ml) with those from patients with persistent suppressed viraemia using a more sensitive version of the Amplicor assay adapted to permit detection of 3 copies/ml.
RESULTS: There was no direct correlation between the level of viraemia measured at baseline by highly sensitive method and the evolution of CD4 cell count during the follow-up. Eight out of 43 patients had at least one episode of blip during the follow-up (median level=350 copies/ml). Comparing patients with and without blip, the median level of HIV-1 RNA at baseline was7.5 copies/ml versus 3 copies/ml (P=0.008). Interestingly, patients with blip had significantly lower CD4 cell count at 12 and 18 months than patientswithout blip. Efficient plasma levels of NNRTI at the time of blip were measured.
CONCLUSION: These results suggest that transient viraemic episodes may be markers of ongoing viraemia below 50 copies/ml and can impair the CD4 cell count recovery. The impairment of CD4 cell count recovery seems to be affected by the occurrence of blips rather than by the level of viraemia below 50 copies/ml itself.
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