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Clinical progression reduced in incomplete HAART responders
  NEW YORK (Reuters Health) - HIV seropositive patients with partial immunologic or virologic responses to highly active antiretroviral therapy (HAART) are at relatively low risk of clinical progression.
However, Italian researchers report in the June issue of the Journal of Medical Virology, the risk is greater than that seen in complete responders.
Lead investigator Dr. Emmanuele Nicastri told Reuters Health that "patients with virologic only response or with immunologic only response had a significantly reduced risk for clinical progression than nonresponders."
Dr. Nicastri of the University of Rome Tor Vegata and colleagues note that the duration of clinical, virologic, and immunologic response to HAART is not well defined. To investigate further, the researchers conducted an observational study of more than 2100 HIV patients beginning protease inhibitor-based HAART.
Using virologic suppression and immune recovery after 12 months of HAART as criteria, they were classified as complete responders (36.4%), immunologic only responders (20.6%), virologic only responders (15.7%) or nonresponders (27.3%).
Older age was directly associated with a virologic-only response and inversely associated with an immunologic-only response.
After 4 years, compared to responders, the clinical progression rate was 6.0 times greater in nonresponders, 2.3 times greater in immunologic-only responders and 1.9 times greater in virologic-only responders.
Nevertheless, patients with incomplete responses were at significantly reduced risk of clinical progression than were nonresponders (p<0.001).
During the 4-year follow-up "less than 10% of patients exhibiting [an] immunologic-only or virologic-only response to HAART experienced death or a new AIDS-defining illness," the researchers conclude.
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