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Short-term risk of AIDS in HIV-positive individuals helps guide initiation of therapy
  By Megan Rauscher
NEW YORK (Reuters Health) - Researchers in the UK have used data from the era before highly active antiretroviral therapy was available to estimate the short-term (3 to 6 month) risk of the developing AIDS in asymptomatic HIV-infected individuals. "Up to now, we have not had estimates available which allow doctors to actually quantify this risk," Dr. Andrew Phillips from Royal Free & University College Medical School in London told Reuters Health.
Dr. Phillips, and others with the CASCADE (Concerted Action on SeroConversion to AIDS and Death in Europe) collaboration, assessed the risk of AIDS in 3226 HIV-infected patients for whom viral load and CD4 cell counts were known prior to initiation of antiretroviral therapy or during zidovudine monotherapy.
During a total of 5126 person-years of follow-up, 219 subjects developed AIDS.
According to the team, for subjects with CD4 cell count < 200 cells per microliter, the risks of developing AIDS in 6 months were 4.9%, 12.7%, 17.7%, and 22.4% for viral loads of <10,000, 10,000-29,999, 30,000-99,999, and >100,000 copies/mL, respectively.
For people with CD4 counts of 200-349 cells per microliter, risks were 0.5%, 1.6%, 3.2%, and 4.7%, respectively for the four viral load groups, while for those with CD4 counts > 350 cells per microliter, risks were 0.2%, 0.5%, 0.9% and 2.2%, respectively.
Supporting prior studies, older individuals had higher risk of AIDS for a given CD4 cell count than younger people, the researchers note in their report in the January 2nd issue of the journal AIDS.
"This paper," Dr. Phillips commented to Reuters Health, "provides useful information to doctors who are assessing a patient and wondering whether to start antiretrovirals or perhaps to wait and re-assess the situation at the patient's next visit, typically in 3-6 months time."
AIDS 2004;18:51-58.


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