Monitoring HAART in HIV-Infected Parents in Thailand


Principal Investigator:
Marc Lallemant

Immunology+Infectious Diseases Thailand

Dates of Research:
September 9, 2003 — April 30, 2011


Implementation of highly active antiretroviral therapy (HAART) has led to a substantial decrease in HIV-related mortality and morbidity. With this important advance, however, has come a monitoring and decision-making process whose complexity challenges the medical care system, particularly in regions where there are large numbers of HIV-infected patients and relatively limited financial and health care resources. Current guidelines emphasize maximal and durable viral load (VL) suppression. However, while successful therapy is demonstrated by restoration of immunity, treatment failure is usually defined as the inability to maintain undetectable viral load, without regard to immune function. This situation often leads to a rapid sequence of therapeutic switches, thus narrowing therapeutic options over time. A monitoring strategy driven primarily by the patient’s immune restoration would most likely be as effective in preventing disease progression, would lead to fewer changes in HAART regimens and would be considerably simpler and cost effective. The primary objective is to compare the clinical outcomes of the standard antiretroviral monitoring strategy based on VL (VL-S), with a simpler strategy based on CD4+ cell count (CD4-S). An important secondary objective is to compare the ability of these two strategies to preserve treatment options. The study will take place at 29 study sites throughout Thailand and the study population will be 700 HIV infected women or men.