Open AccessProgression to AIDS or death in HIV‐infected patients initiating cART with CD4<200 cells/µ L: the role of CD4 and viral load changes during follow‐up
Author(s) -
Ferrer E,
Curto J,
Esteve A,
Miro J,
Tural C,
Riera S,
Segura F,
Force L,
Casabona J,
Podzamczer D
Publication year - 2012
Publication title -
journal of the international aids society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.724
H-Index - 62
ISSN - 1758-2652
DOI - 10.7448/ias.15.6.18148
Subject(s) - medicine , viral load , cart , proportional hazards model , gastroenterology , human immunodeficiency virus (hiv) , survival analysis , cause of death , immunology , disease , mechanical engineering , engineering
Purpose of the study Our aim was to evaluate factors associated with progression to AIDS/death in HIV‐infected naïve pts initiating cART with low CD4 counts. Methods Adult HIV‐infected ARV‐naïve pts with CD4 <200 who initiated NNRTI or PI‐containing regimens between 1998 and 2009, were included. Primary end point was progression to AIDS (a first episode or a new AIDS‐defining condition in pts with prior AIDS) or death. Kaplan‐Meier curves were used to determine progression‐free survival and multivariate Cox regression models were used to identify independent predictive factors of progression to AIDS/death. Summary of results We included 1427 patients (80% men, median age 38 years, 25% IDU, 37% AIDS, 20% HCV) between 1998 and 2009. At baseline (BL), median (range) CD4 and viral load (VL) was 77 (1–199) cells/µL and 170,000 (19–8,750,000) copies/mL, respectively. After a median follow‐up 4.6 years, 70% of pts reached CD4>200/µL, 65.2% reached undetectable VL and 268 (19%) pts progressed to AIDS/death during follow‐up. The probability of AIDS/death at 5 years was 76%, 34%, 3% and 3%, in pts with BL CD4<100/VL>5 log and CD4<200/VL detectable during FU, BL CD4<100/ VL>5 log and CD4<200/VL undetectable during FU, BL CD4<100 and/or VL>5 log and CD4>200/VL undetectable during FU and BL CD4>100/ VL<5 log and CD4>200/VL undetectable during FU, respectively. In the multivariate analysis, several variables were associated with AIDS/death: CD4< 200 during FU (HR 10.89, p<0.001), detectable VL during FU (HR 3.49, p<0.001), age>50 years (HR 1.75, p=0.001), prior AIDS (HR 1.71, p<0.001) and BL VL>5 log (HR 1.45, p=0.011). If only pts without prior AIDS (n=895) were analyzed, the variables independently associated with AIDS/death were: CD4<200 during FU (HR 9.90, p<0.001), detectable VL during FU (HR 2.78, p<0.001) and BL VL>5 log (HR 1.62, p=0.016). Conclusions In immunosuppressed patients initiating cARV therapy, not reaching CD4>200/µL during FU was the strongest variable associated with progression to AIDS/death. VL at BL and mainly at follow up also played a role in patient outcome.