RTB: Improvement and recovery from Aids requires addressing all factors influencing health, and pushing back from the two major surrogate markers that dominate all current Aids treatment protocols: Viral Load and T-Cells. These surrogate markers fail to address or correlate with actual health concerns. Aids patients must push back from the mainstream’s slavish devotion to these two laboratory markers, and embrace a more complex view of health.
“Plasma HIV RNA (viral load) measurements predict no more than 9% of the rate of CD4 cell loss in untreated HIV-positive individuals, according to the findings of a large, retrospective multiple cohort study published in the September 27th edition of the Journal of the American Medical Association. An accompanying editorial argues that these findings “have several important clinical implications.” Not only should viral load measurements play a diminishing role in informing decisions regarding when to start antiretroviral therapy, it argues, but now that we understand that unique genetic and immunological factors affect more than 90% of CD4 cell depletion on an individual level, “future improvements in the treatment of HIV infection and AIDS,” are bound to follow.
To confirm this surprising finding, the investigators used the same statistical methods on the 1512 individuals in the MACS cohort (whose data is available in the public domain) and found that just 6% (95% CI, 4-8%) of CD4 cell count changes over six months could be accounted for by the viral load measurement taken at the start of the six months.”
In challenging the reliability of the CD-4 count in evaluating AZT, the Concorde study rekindled a long simmering dispute between many European and American researchers over the validity of surrogate markers in H.I.V. and AIDS.
Don’t rely on TCells as Surrogate markers…
“A total of 172 (96 Imm, 76 Def) participants died [169 while taking AZT, 3 while on placebo]“… The results of Concorde do not encourage the early use of zidovudine in symptom-free HIV-infected adults. They also call into question the uncritical use of CD4 cell counts as a surrogate endpoint for assessment of benefit from long-term antiretroviral therapy… Representatives of the Wellcome Foundation who were also members of the Coordinating Committee have declined to endorse this report.”
Concorde Coordinating Committee, Concorde: MRC/ANRS randomised double-blind controlled trial of Immediate [Imm] and deferred [Def] zidovudine in symptom-free HIV infection, The Lancet, Vol 343, April 9, 1994.
Aids patients have a right to do more than refer to these 2 surrogate markers for all or any major or minor decisions about health.