In a surprising paradox, HIV-positive adults who begin highly active antiretroviral therapy with higher CD4-cell counts may be at a greater risk of immunological failure than those who start HAART with far fewer CD4 cells. A study in the July 1 edition of The Journal of Infectious Diseases shows that of 2,372 HIV-positive adults starting HAART, 11.1% experienced treatment failure within 12 months, most of whom had higher than average baseline CD4 counts.
Injection drug use and elevated viral loads during anti-HIV therapy also were linked to treatment failure.
The researchers say one reason those with lower baseline CD4-cell counts did better on HAART may be that they modified their regimens more quickly and more often to promptly prevent further immune system damage. Those with higher initial CD4 counts also may have been less adherent to their regimens because they felt they were at a lower risk of developing AIDS-related opportunistic infections.
