[Predictors of progression and death in patients with advanced HIV infection in the era of highly active antiretroviral therapy].
BACKGROUND
To assess the factors associated with progression of infection and death in HIV-positive patients with severe immunodepression in the era of highly active antiretroviral therapy (HAART).


METHODS
We studied 146 HIV-infected patients with < 100 x 10(6)/L CD4+ lymphocytes and positive cytomegalovirus (CMV) serology enrolled between December 1997 and October 1998 and prospectively followed a median of 12.1 months. The main outcome measures were progression of HIV infection, defined as the appearance of a new AIDS-defining disease (CDC category C) or death. HIV viral load, lymphocyte count (CD4+ and CD8+), HAART administration and other clinical variables were evaluated at baseline. CMV viremia (determined by PCR) and HAART efficacy were recorded during follow-up.


RESULTS
Progression was observed in 40% of patients and 17% died. Factors associated with progression or death were CD4+ lymphocyte count less than 50 x 10(6)/L, CD8+ lymphocyte count less than 500 x 10(6)/L, HIV viral load more than 300,000 copies RNA/mL, CMV viremia, and absence or inefficacy of HAART. In the multivariate model, absence of HAART and low CD4+ and CD8+ counts remained statistically associated with progression, but the only variable associated with death was CMV viremia.


CONCLUSIONS
In patients with advanced HIV infection, CD4+ and CD8+ cell count and HAART were the most important factors related to progression, and CMV viremia was the strongest predictor of death.
Reus
Sergio
S
Servicio de Enfermedades Infecciosas. Hospital General Universitario de Alicante. Spain.
Portilla
Joaquín
J
Gimeno
Adelina
A
Sánchez-Payá
José
J
García-Henarejos
J A
JA
Martínez-Madrid
Onofre
O
Usó
Jordi
J
Roca
Bernardino
B
Galindo
María José
MJ
López-Aldeguer
José
J
D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology; D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy / Q000401:mortality*; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D016516:CD4-CD8 Ratio; D015897:Comorbidity; D003586:Cytomegalovirus Infections / Q000453:epidemiology*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D017211:Treatment Failure; D019562:Viral Load; D014766:Viremia / Q000188:drug therapy / Q000401:mortality*