TAHOD Paper Explores Occurrence of Immune Problems Under HAART

Immune Reconstitution Syndrome “Relatively Uncommon” in Asia

September 2007—Highly active antiretroviral therapy (HAART) has proven to be remarkably effective at prolonging the lives of people with HIV, in economically developed as well as resource-limited regions. However, a large number of HIV-positive people do not reap the full benefit of these medications because their HIV diagnoses come too late or they do not have access to these vital medications. (In the U.S., around one-third of HIV diagnoses are followed by AIDS diagnoses within one year.) A paper published in the July issue of the International Journal of STD and AIDS by researchers with the TREAT Asia HIV Observational Database (TAHOD) examined the implications of this treatment conundrum among patients in Asia.

As HAART has become increasingly available in Asia, health-care workers confront difficulties posed by limited resources and manpower, but one of the most significant challenges involves the timely identification of patients who are ready to initiate antiretroviral therapy. Following a cohort of 1,246 HIV-positive patients, TAHOD researchers analyzed AIDS-defining illnesses diagnosed within 90 days after starting HAART, with a particular focus on the occurrence of a condition known as immune reconstitution syndrome. While the ultimate aim of HAART is the restoration of immune response, partial restoration of the immune system may generate an undesirable inflammatory response against other infections.

Identifying immune reconstitution syndrome from observational data is not simple, noted the authors of the TAHOD article, because no consensus on diagnostic standards currently exists. “Given that antiretroviral treatment scale-up programs in resource-limited settings are often relying on health-care workers who lack the detailed clinical knowledge of managing HIV infection, concerns are sometimes raised about the difficulties of managing complications of antiretroviral treatment such as immune reconstitution syndrome,” the researchers explained.

Results of the study, however, were reassuring. “In spite of the relatively high rates of co-infection with tuberculosis and the relatively advanced stage of disease at which patients started HAART,” the authors wrote, immune reconstitution syndrome was found to be “relatively uncommon” in Asia—a finding indicating that the effective management of HIV/AIDS in Asia may face one less obstacle.