EU funded research gives hope to HIV patients
EU-funded researchers have demonstrated that long term treatment of HIV patients with combination antiretroviral therapy (cART) can boost CD4 immune cells to the same level as found in HIV negative people. The study, which is published online by the prestigious journal the Lancet, was carried out in the framework of the EuroSIDA project, which has been funded under successive EU framework programmes since 1994. People with HIV suffer from a loss of CD4 immune cells, weakening their immune systems and making them more vulnerable to a whole range of infections. Combination antiretroviral therapy is designed to reduce HIV viral replication to below the limits of detection. As viral replication decreases, the CD4 count increases. The goal of this latest study, which was led by Amanda Mocroft of the Royal Free and University College Medical School in London, was to monitor the long term effects of cART on CD4 count in patients who have achieved maximum virological suppression. At the start of the study, the average CD4 count was just 200 cells per microlitre. The steepest increase was seen in the first year, but after that the cell count continued to rise, albeit more slowly. 'Most patients continued to have significant rises in CD4 count, even at more than five years after cART initiation,' the researchers write. 'In conclusion, we have shown that most patients with HIV who can maintain viral load at less than 50 copies per millilitre continue to have significant rises in CD4 counts, even after protracted exposure to combination therapy.' By the end of the study, patients who started off with higher CD4 counts (over 350 cells per microlitre) were approaching levels seen in HIV negative people, i.e. around 800 cells per microlitre. Longer follow-up is needed to see if patients with lower CD4 counts at the start of therapy can eventually reach these levels. 'The increase in CD4 cell count will result in a corresponding reduction on the risk of opportunistic diseases or death associated with HIV, as the CD4 count, rather than viral load, remains one of the strongest markers of clinical disease progression,' the researchers note. However, the scientists emphasise that their results only apply to patients who have an optimum response to cART. 'Up to 30% of patients starting cART will not achieve viral suppression and the CD4 counts in these patients will not increase to the same extent,' they warn. 'Many cART regimens are associated with both long and short term toxicities, treatment interruptions are common and viral load might not always be maintained at such a low level.'