HAART for a Life Time (not a Good Time)?

“In the industrialised world the availability of highly active antiretroviral treatment (HAART) for advanced HIV-1 disease has dramatically improved patients’ life expectancy. However, an unfailing lifelong commitment to antiviral drugs is expected. Furthermore, recent evidence is mounting that cardiovascular and cerebrovascular accidents might seriously impair the health of infected individuals [oops, your heart stopped!], and the resulting morbidity and mortality have put an end to the unlimited optimism that was associated with the beginning of the HAART era.”

“It is more and more difficult to imagine anti-HIV treatments as life-long prescriptions, given the side effects described in the long terms, such as lipodystrophy (found [in this study of 41 patients] in nearly 60% of patients), metabolic disturbances, a possibly increased cardiovascular risk, mitochondrial toxicity and altered quality of life. In other words, the inconvenience of a very-long-term treatment may outweigh the benefit of maintaining the CD4 cell count at a high level, considering that treatment beyond 2 to 4 years will not result in a significant reduction of the HIV-1 DNA load…In summary, the data presented here show that HIV-1 DNA does not seem influenced by HAART after the third year and confirm that the CD4 cell count gain is less apparent after 18 months on treatment. Based on these observations, we question the benefits of a life-long treatment for HIV infection”

“children who had received combination therapy were estimated to have a non-[statistically-]significantly increased rate of clinical progression”

“The effect of highly active antiretroviral therapy (HAART) in the treatment of HIV infection is usually measured by survival, CD4 lymphocyte counts, HIV-1 RNA viral load testing, and the occurrence of opportunistic infections. This pilot study sought to measure the impact of HAART treatments on a wide range of clinical outcomes and psychological variables...The only psychosocial measure that improved significantly with treatment was depression. Ratings of pain intensity, physical and psychological symptom distress, and overall quality of life did not change. Of the 70 patients studied, 84% were still alive after the 3-month study period...17 surviving patients (24%) had HAART regimens discontinued due to drug intolerance and 11 (16%) expired [died] during the study period...During the 3-month period [the following illnesses arose - ] wasting syndrome (4), AIDS dementia (1), resistant esophageal candidiasis [fungal throat infection] (1) and acute herpes zoster (1). In addition, there were a number of other infectious medical events that occurred...The causes of death were progressive wasting (5), bacterial pneumonia (3), disseminated Kaposi sarcoma (1), non-Hodgkin lymphoma (1) and end-stage renal disease (1)”

“Other factors associated with lower cumulative survival included suppressed CD4 cell counts, a history of zidovudine [AZT] therapy [Table 1 shows that children who had taken AZT had a 37.5% risk of death over the study period versus 22.8% for those who had not. There was a 97% probability that this increase was not due to chance], and Pneumocystis carinii pneumonia diagnosed before the initial echocardiogram.”

“The comparison of the two studies [one European, one French]…is interesting. Despite the wider and earlier use of zidovudine [AZT] monotherapy in the French study, morbidity or mortality was similar to that in the ECS [European Collaborative Study]. This is further indirect evidence of lack of benefit from long-term zidovudine monotherapy”

“Only 38% of the HLP [Healthy long-term positives] had ever used zidovudine [AZT] or other nucleoside analogues, compared with 94% of the progressors.”