METAANALYSIS OF ANTIRETROVIRAL EFFECTS ON HIV-1 RNA, CD4 CELL COUNT AND PROGRESSION TO AIDS OR DEATH

There is uncertainty as to how the effects of antiretroviral treatment s on human immunodeficiency Virus type 1 (HIV-I) RNA levels and CD4 ce ll counts can predict reductions in clinical progression to AIDS or de ath. A meta-analysis war conducted for 27 pairwise comparisons of anti retroviral treatments in 15 randomized trials of antiretroviral treatm ents, For each trial. three measures of treatment effect were used: (i ) 16 week change from baseline in HIV-I RNA; (ii) 16 week change from baseline in CD4 cell count; and (iii) rate of clinical progression. Tr eatments which caused greater increases in CD4 cell count and greater reductions in HIV-1 RNA were move effective at reducing the rate of cl inical progression (P<0.05 for each comparison). However. there was va riability in the consistency of this correlation between different tri als and treatments. The results support the use of both CD4 count and HIV-I RNA levels as the primary markers of the efficacy of antiretrovi ral treatment.