Toronto

Last week, I submitted an abstract to the XVI International AIDS Conference in Toronto, Canada. I had expected just to throw something together, but this actually took up a good bit of my time. It was really difficult to keep it under the 300 word minimum. It is the result of work I have been doing for the past several months, so its kind of a brief summary of what the heck I have been doing over here. I am actully slightly proud of it, but know that it is one of 12,000 abstract submissions to the biggest AIDS conference in the world. I belive my chances of being accepted are quite slim. Regardless here is my official submission:

Response to highly active antiretroviral therapy among patients with CD4 counts below 50 cells/mm³ in a resource-constrained setting

Background: AIDS patients in the developing world often present for HAART with lower CD4 counts and more advanced disease. This study provides data on how patients with advanced AIDS respond to HAART in a resource-constrained setting in South Africa.

Methods: Fifty HIV+ patients with CD4 counts below 50 were paired with sex and age matched controls with CD4 counts above 100. Non-ambulatory patients with complicated opportunistic infections or Karnofsky scores below 70 were referred out. All patients were initially commenced on a once daily HAART regimen of efavirenz, lamivudine, and didanosine. Patients were seen by a clinician monthly. CD4 count and viral load were measured at 6 month intervals.

Results: The mean baseline CD4 and viral load of the CD4 below 50 group was 22.5 cells/mm3 and 363,795 copies/ml respectively, while that of the CD4 greater than 100 group was 151.7 cells/mm3 and 286,577 copies/ml. During the first 10 months of therapy, 8 patients in the CD4 below 50 group and 1 patient in the CD4 greater than 100 group died from AIDS related illnesses. After 6 months of therapy, 64.8% of the CD4 below 50 group and 97.8% of the CD4 greater than 100 group achieved complete viral suppression. The 6 month CD4 count increased to 137.0 cells/mm3 in the CD4 below 50 group and to 271.6 cells/mm3 in the CD4 greater than 100 group.

Discussion: The risk of death for patients with CD4 below 50 was RR 8 (95% CI 1.5 - 42.7) compared to the CD4 greater than 100 group. Among the 8 deaths, 6 patients died within the first 2 months of therapy. It is likely that these patients presented too late for treatment and never underwent complete immune reconstitution. Among the survivors, fewer patients in the CD4 below 50 group achieved viral suppression at 6 months [RR 0.7 (0.5 - 0.8)]. These findings highlight the importance of identifying AIDS patients at an earlier stage of disease with CD4 counts greater than 100 for initiation of HAART.