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Peter Erb, PhD; Manuel Battegay, MD; Werner Zimmerli, MD; Martin Rickenbach, PhD; Matthias Egger, MD; for the Swiss HIV Cohort Study

Arch Intern Med. 2000;160:1134-1140.

Objective  To examine the effect of different antiretroviral treatment regimens on viral load, CD4 lymphocyte counts, and rates of progression to clinical acquired immunodeficiency syndrome events among treatment-naive human immunodeficiency virus (HIV)–infected patients enrolled in a large community cohort study.

Methods  Based in 7 outpatient clinics, the Swiss HIV Cohort Study is a cohort with national coverage. Virological, immunologic, and clinical results of 755 treatment-naive patients (median age, 36 years; 28.2% female) who initiated antiretroviral therapy between July 1, 1995, and June 30, 1997, were analyzed. Patients started undergoing monotherapy with 1 reverse transcriptase inhibitor (RTI), combination therapy with at least 2 RTIs, or highly active antiretroviral therapy (HAART) with RTIs and protease inhibitors.

Results  Antiretroviral treatment led to a mean reduction of viremia of 1.8 log₁₀ copies per milliliter with HAART, 1.2 log₁₀ copies per milliliter with RTI combination therapy, and 0.4 log₁₀ copies per milliliter with monotherapy. Virological failure, defined as less than 1 log₁₀ reduction per milliliter in viremia, was present in 45 (20%) patients undergoing HAART, 180 (38%) undergoing RTI combination therapy, and 47 (82%) undergoing monotherapy. The proportion of patients reaching undetectable viremia was 12% (n=7) for monotherapy, 41% (n=197) for RTI combination therapy, and 63% (n=137) for HAART. Similar gains of CD4 cells were achieved with RTI combination therapy and HAART. Kaplan-Meier estimates of progression rates to a new acquired immunodeficiency syndrome event at 18 months were 13.6% (monotherapy), 4.7% (RTI combination therapy), and 3.9% (HAART).

Conclusions  The rate of virological failure of antiretroviral treatments was high in this population of treatment-naive patients, even among patients receiving combination regimens. Clinical progression rates were, however, low in patients treated with RTI combination therapy and HAART.

From the Basel Center for HIV Research (Drs Erb, Battegay, and Zimmerli), the Institute for Medical Microbiology, University of Basel (Dr Erb), and the Department of Internal Medicine, University Hospitals of Basel (Drs Battegay and Zimmerli), Basel, Switzerland; Coordination and Data Center, Swiss HIV Cohort Study, CHUV, Lausanne, Switzerland (Dr Rickenbach); and MRC Health Services Collaboration and Department of Social Medicine, University of Bristol, Bristol, England (Dr Egger).

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