[Risk factors related to infections during the first year of highly active antiretroviral therapy].
BACKGROUND
To evaluate the immunological, virological and clinical response of HIV-infected patients who start combined therapy with protease inhibitors (PI) in a community hospital. To identify risk factors related with infections.


METHODS
Clinical review of patients with combined therapy, assessing CD4+ cell counts, viral load (Amplicor) and development of infections during the first year on PI (group A) and comparative study with the same patients during the previous year with PI (group B).


RESULTS
134 patients were included in group A and 84 in Group B. Nadir of CD4+ was 169 X 10(6)/l. After 6 months of PI therapy, the mean CD4 increased from 217 to 355 X 10(6)/l and the median viral load decreased from 88,000 copies/ml (14,000-485,000) to less than 400 copies /ml (< 400-9,000), 60% of patients had less than 400 copies/ml. The incidence of non-opportunistic infections was similar in both groups (36 vs 43%; p = NS). However, the rate of opportunistic infections decreased from 30 to 15% (RR: 0.41 [CI 0.21-0.81]; p = 0.007) in the group with PI, particularly Pneumocystis carinii pneumonia and toxoplasmosis. Multivariated analysis including CD4+ cell count, nadir of CD4+, viral load and risk behavior only nadir of CD4 < 100 X 10(6)/l was associated with a lower risk of developing opportunistic infections (RR: 0.2 [CI: 0.1-0.7]; p = 0.001).


CONCLUSIONS
Combined therapy with PI improved immunological and virological markers and decreased the rate of opportunistic infections. A CD4+ cell count nadir higher than 100 X 10(6)/l was a marker of good prognosis during the first year with PI irrespective of response to therapy.
Amador
C
C
Servicio de Medicina Interna. Hospital Marina Baixa. Villajoyosa. Alicante. c.amador@coma.es
Bodi
V
V
Pasquau
F
F
Ena
J
J
Benito
C
C
Fenoll V
F
F
D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology*; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000503:physiopathology; D017320:HIV Protease Inhibitors / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D012307:Risk Factors; D019562:Viral Load
D017320:HIV Protease Inhibitors