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This article is part of the supplement: The OptAIDS project: towards global halting of HIV/AIDS

Open Access Research

Quantifying the treatment efficacy of reverse transcriptase inhibitors: new analyses of clinical data based on within-host modeling

Romulus Breban12, Sonia Napravnik3, James Kahn4 and Sally Blower15*

Author Affiliations

1 Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, CA 90024, USA

2 Unité d'Épidémiologie des Maladies Émergentes, Institut Pasteur, Paris, France

3 School of Medicine, University of North Carolina, Chapel Hill, NC 27599, USA

4 Positive Health Program, San Francisco General Hospital and the University of California, San Francisco, CA 94143, USA

5 UCLA AIDS Institute, David Geffen School of Medicine, University of California, Los Angeles, CA 90024, USA

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BMC Public Health 2009, 9(Suppl 1):S11  doi:10.1186/1471-2458-9-S1-S11

Published: 18 November 2009

Abstract

Background

Current measures of the clinical efficacy of antiretroviral therapy (ART) in the treatment of HIV include the change in HIV RNA in the plasma and the gain in CD4 cells.

Methods

We propose new measures for evaluating the efficacy of treatment that is based upon combinations of non-nucleoside and nucleoside reverse transcriptase inhibitors. Our efficacy measures are: the CD4 gain per virion eliminated, the potential of CD4 count restoration and the viral reproduction number (R0). These efficacy measures are based upon a theoretical understanding of the impact of treatment on both viral dynamics and the immune reconstitution. Patient data were obtained from longitudinal HIV clinical cohorts.

Results

We found that the CD4 cell gain per virion eliminated ranged from 10-2 to 600 CD4 cells/virion, the potential of CD4 count restoration ranged from 60 to 1520 CD4 cells/μl, and the basic reproduction number was reduced from an average of 5.1 before therapy to an average of 1.2 after one year of therapy. There was substantial heterogeneity in these efficacy measures among patients with detectable viral replication. We found that many patients who achieved viral suppression did not have high CD4 cell recovery profiles. Our efficacy measures also enabled us to identify a subgroup of patients who were not virally suppressed but had the potential to reach a high CD4 count and/or achieve viral suppression if they had been switched to a more potent regimen.

Conclusion

We show that our new efficacy measures are useful for analyzing the long-term treatment efficacy of combination reverse transcriptase inhibitors and argue that achieving a low R0 does not imply achieving viral suppression.