Health authorities recommend HIV-infected patients starting treatment as soon as posible after diagnosis, regardless of the level of immunosuppression (which are measured by the number of CD4, cells responsible for the immune response and which are infected by the virus) and viral load.
“The problem is the reality that we live in the healthcare” said Dr. Daniel Podzamczer, head of the HIV and STD Unit of the Infectious Diseases at the University Hospital of Bellvitge (HUB) and researcher at respiratory infections the immunocompromised host group of the Bellvitge Biomedical Research Institute (IDIBELL). “Patients often arrive severely immunocompromised, 66% of them with CD4 <500 cells per mm3 and in this study we wanted to observe the evolution of patients who are late for treatment, which in our case are approximately 22% with CD4 <200 cells mm3 “.
The study, published in the Journal of Antimicrobial Chemotherapy, was performed with patients in the cohort PISCES (with the collaboration of other hospitals and CEEISCAT) that includes more than 17,000 HIV-infected patients in several hospitals in Catalonia and the Balearic Islands. It has monitored for five years 2,300 patients who had started treatment when CD4 levels very low, less than 200 cells per mm3.
What we have observed is that 78% of patients who do not respond to treatment and don’t increase in CD4 and with a drop in viral load, progress to AIDS or die. However, if not recovered the immune response but their viral load is undetectable, mortality and progression to AIDS decreases to 35%. If an undetectable viral load is not achieved but the CD4 count rises above 200, the downward progression of disease in 18%. That is, the immune recovery is more important than virological response but it also plays a key role.
“Furthermore, if the patient has begun treatment in such harsh conditions but recuperates immunological levels above 200 cells per mm 3 and an undetectable viral load, disease progression to AIDS or death at 5 years of follow-up It is only 2%, said Dr. Elena Ferrer, first author of the study, medical Unit HIV and STDs, research group of respiratory infections in the immunocompromised host at IDIBELL and medical service of infectious diseases at HUB.
According to Dr. Podzamczer “Even in the worst case, you can fight the disease progression, but we must not forget that 30% of these patients failed to recover the immune response. And the recommendation has to be still diagnosed and treat the patient as soon as possible, so the task of prevention and information to society is needed. ”
Ferrer E * J Curto, Esteve A, Miro JM, Tural C, Murillas J, Segura F, P Barrufet, Casabona J, Podzamczer severaly D. Clinical Progression of HIV-Infected patients immosuppressed depends on Virological and immunological imrpovement irrespective of baseline status . J Antimicrobial Chemother. 2015 Sep 25. PII: dkv272. [Epub ahead of print]