HIV Health News

Adherence More Important than CD4 Cell Count 

In the November 18, 2003 issue of the Annals of Internal Medicine, Evan Wood, PhD, and colleagues from the University of British Columbia in Vancouver reported that anti-HIV therapy can safely be delayed until CD4 cell count falls to 200 cells/mm³. However, once they start treatment, individuals must maintain good adherence to benefit from therapy. The HAART Observational Medical Evaluation and Research (HOMER) study included 1,422 participants who started combination anti-HIV therapy between 1996 and 2000. Among individuals who maintained at least 75% adherence, those who started treatment with a CD4 cell count of 200 cells/mm³ were as likely to survive as those who started with a CD4 cell count of 350 cells/mm³ or higher (a mortality rate of about 7%). However, those who achieved less than 75% adherence had a mortality rate more than twice as high (about 15%)-- even if they started treatment with a CD4 cell count of 350 cells/mm³ or higher. The latest U.S. treatment guidelines recommend starting therapy when the CD4 cell count falls to 350 cells/mm³, but this study suggests that adherence is more important than when HAART is initiated.

Bone Loss May Be Linked to HIV, Not Therapy 

Bone loss is associated with HIV infection itself, not antiretroviral therapy, according to a study in the September 5, 2003 issue of AIDS. Dario Bruera, MD, from the National University of Córdoba, Argentina, and colleagues analyzed data from 111 HIV positive and 31 HIV negative subjects; among those with HIV, 33 had never used antiretroviral therapy, 36 had more than one year of treatment without a protease inhibitor (PI), and 42 had more than one year of treatment including a PI. Bone mineral density (lumbar spine, femur, and total body) was significantly lower in the HIV positive compared with the HIV negative subjects, and the incidence of osteopenia and osteoporosis (below average and severely low bone density) was higher in the former group. Those who had been infected with HIV the longest were at greatest risk for bone loss. However, among the HIV positive participants, no differences were seen based on presence or type of antiretroviral therapy. The results suggest that HIV itself has an adverse effect on bone density, the researchers concluded. (For more information, see "Osteoporosis and HIV Disease," BETA, Summer/Autumn 2001; and "Osteonecrosis and HIV Disease," BETA, Winter 2002.)