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Options for HAART may be limited

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A small, but growing, group of patients with HIV in the UK faces the prospect of running out of treatment options if new antiretroviral drugs do not become available soon, a multicentre cohort study has predicted. These drugs will need to have low toxicity and not be subject to cross resistance to existing ones.

The UK collaborative HIV cohort (CHIC) study compared immunological and viral status among patients who had ever had highly active antiretroviral treatment, patients exposed to the three main classes of antiretroviral drugs, and patients showing viral load failure with that treatment, in more than 16 500 HIV infected adults during 1996–2002.

Patients most at risk are thought to be among those exposed to the three main classes of antiretroviral drugs, comprising 38% of treated patients in 2002—namely, the quarter with viral load failure. Their proportion has been rising steadily, and the proportions with CD4 counts<200 cells/mm3 and HIV RNA >2.7log10 copies/ml were high. Overall, 62% of the entire cohort was exposed to any antiretroviral treatment. The percentage that had ever had treatment rose from 41% initially to 71% in 2002, and the proportion with CD4 <200 cells/mm3 and HIV RNA >2.7log10 copies/ml fell, indicating successful control.

Patients with viral load failure with three treatments may have some resistance to other drugs in the same class and high risk of future treatment failure. Successive treatments tend to produce shorter term immunological and viral control, so that patients who have worked through several regimens may eventually have no other options.

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