"Improvement in CD4 Cell Counts Despite Persistently Detectable
HIV Load"
New England Journal of Medicine (04/09/98) Vol. 338, No. 15, P.
1074; Levitz, Stuart M.; Letter
ÿÿÿÿ Stuart M. Levitz of the Boston Medical Center illustrates two
cases of HIV-infected patients with elevated viral loads despite
antiretroviral therapy and comments on options for the patients in
a letter to the editor of the New England Journal of Medicine. He
notes that one major goal of antiretroviral regimens is to reduce
the HIV viral load in patients and that patients who fail
treatment are left with few medical options due to the limited
number of drugs available, cross-resistance, antagonism, and
adverse effects.ÿ Levitz describes two patients who failed
antiretroviral treatment of zidovudine, didanosine, stavudine, and
lamivudine, either in combination or alone.ÿ Patient 1 presented
in 1992 with a CD4 cell count of less than 40 cells/microliter,
and Patient 2 had a CD4 cell count of less than 30
cells/microliter in 1993.ÿ In late 1996, Patient 1 was switched to
a regimen consisting of nelfinavir, didanosine, lamivudine, and
stavudine, while Patient 2 initiated a ritonavir, saquinavir,
didanosine, and stavudine regimen early the next year.ÿ Both
showed substantial increases in CD4 cell counts at the most recent
assessment, with Patient 1 reporting 526 CD4 cells/microliter and
Patient 2 showing 375 CD4 cells/microliter. Despite the fact that
both still had elevated HIV viral loads, neither patient has had
further opportunistic infections and both have returned to work or
school.ÿ The findings show that CD4 cell increases can occur even
in the presence of relatively high viral loads, Levitz noted,
warning that the duration of the increased CD4 cell counts still
needs to be determined. |
