Factors associated with clinical progression in HIV-2 infected-patients: the French ANRS cohort.
OBJECTIVE
To identify factors associated with clinical progression in HIV-2 infected patients.


METHODS
French prospective cohort initiated in 1994.


METHODS
Follow-up data are collected twice a year; viral load is assessed once a year by cellular viraemia, quantitative proviral DNA and plasma RNA. A Cox proportional-hazards model was used for studying baseline factors associated with clinical progression.


RESULTS
By December 2001, 217 patients had been enrolled. At inclusion, 80%, 6% and 14% were Centers for Disease Control and Prevention (CDC) group A, B and C, respectively. Median CD4 cell count was 436 x 10(6)/l. In the 48% of positive specimens, the median plasma RNA titre was 3.0 log10 copies/ml. Mean follow-up of the 179 patients seen at least twice was 34.4 months. Of these 13 died and nine progressed to group C. Ninety-three (52%) received antiretroviral therapy during a mean of 33 months, including a protease inhibitor in 48%. The probability of remaining AIDS-free was 97% and 95% at 1 and 3 years, respectively. Independent variables associated with clinical progression were age > or = 40 years [hazard ratio (HR), 11; 95% confidence interval (CI), 1.4-91.8; P = 0.03] and plasma RNA (HR, 2.5 per additional log10 copies/ml; 95% CI, 1.3-4.7, P < 0.01). Prior group B symptoms and CD4 cell count < 200 x 10(6)/l were associated with progression to AIDS. AIDS and plasma RNA were predictive of death.


CONCLUSIONS
Considering the limited progression rate of HIV-2 infection, combined antiretroviral therapy should be discussed in patients with high plasma RNA titres, which threshold value remains to be defined. It is recommended in case of AIDS, CDC group B symptoms or CD4 cell count < 200 x 10(6)/l.
Matheron
Sophie
S
Service des Maladies Infectieuses et Tropicales A, Hôpital Bichat-Claude Bernard, Assistance Publique des Hôpitaux de Paris, France.
Pueyo
Sophie
S
Damond
Florence
F
Simon
François
F
Leprêtre
Annie
A
Campa
Pauline
P
Salamon
Roger
R
Chêne
Genevieve
G
Brun-Vezinet
Françoise
F
D000163:Acquired Immunodeficiency Syndrome / Q000276:immunology; D000328:Adult; D000367:Age Factors; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology; D004279:DNA, Viral / Q000097:blood; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000276:immunology* / Q000401:mortality; D015498:HIV-2 / Q000502:physiology*; D006801:Humans; D008297:Male; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011480:Protease Inhibitors / Q000627:therapeutic use; D012367:RNA, Viral / Q000097:blood; D012307:Risk Factors; D019562:Viral Load
D044966:Anti-Retroviral Agents; D004279:DNA, Viral; D011480:Protease Inhibitors; D012367:RNA, Viral