A decade after beginning triple-drug therapy with very low CD4 counts, a majority of patients in the Belgian PICASSO cohort study remain alive and well. The encouraging data, involving patients who began a protease inhibitor-based regimen in 1996 with fewer than 100 CD4 cells, were reported this week at the 11th European AIDS Conference (EACS) in Madrid.

The PICASSO cohort enrolled 388 HIV-positive people starting a protease inhibitor-based regimen in 1996. All patients had CD4 counts below 100 upon entering the study and were evaluated by the investigators four times during the first year of treatment and every six months thereafter.

According to Agnes Libois, MD, of CHU Saint-Pierre in Brussels, who presented the data at EACS, 77 percent of the patients enrolled were men and 74 percent were white. The average age, upon entering the study, was 39 years and the average length of infection, prior to beginning protease inhibitor therapy, was 69 months.

The average CD4 count upon entering the study was 26 cells and the mean viral load exceeded 100,000 copies. The vast majority of patients had been on antiretroviral therapy in the past—approximately 97 percent had used nucleoside reverse transcriptase inhibitors (NRTIs) upon entering the study.

After ten years, 201 (52 percent) were alive and accounted for in the study. Dr. Libois reported that 130 (34 percent) participants had died, and 62 (16 percent) patients were lost to follow up.

Of the 201 patients still alive and accounted for ten years later, a whopping 70 percent had viral loads below 50 copies—undetectable by today’s standard. The average CD4 count, after a decade, was 364 cells, with 80 percent presenting with CD4s greater than 200 at the last clinic visit.

At the time of their most recent clinic visit, 70 percent of those still alive were on a protease inhibitor-based regimen; 18 percent were on a non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimen and 12 percent were on a triple-NRTI or other treatment regimen.

In conclusion, Dr. Libois and the other authors noted, ten-year survival rates among people initiating triple-drug treatment, despite advanced immune suppression, are high—with an overwhelming majority of those still alive maintaining durable virologic suppression.