Response to highly active antiretroviral therapy at 6 months and long-term disease progression in HIV-1 infection.
OBJECTIVE
To compare the long-term prognostic significance of different definitions of immunologic and virologic responses to highly active antiretroviral therapy (HAART) at 6 months.


METHODS
This was a prospective study conducted in 68 French hospitals. HAART was initiated in 2236 protease inhibitor-naive patients included in the French Hospital Database on HIV. Multivariate Cox proportional hazard models measuring time from 6 months after starting HAART were used to compare the strength of the association between different definitions of immunologic and virologic responses at 6 months and subsequent progression to AIDS or death. The Akaike's Information Criteria were used to identify the most appropriate model.


RESULTS
During a median follow-up of 58 months, 325 patients experienced an AIDS-defining event or died. The model that fitted best was the model in which the CD4 cell count and plasma HIV-1 RNA values attained at 6 months were considered. The risk of clinical progression at 5 years ranged from 7% (95% confidence interval [CI]: 4-10) in patients whose CD4 cell count at 6 months was >or=350 cells/microL and whose HIV-1 RNA concentration was <3 log10 copies/mL to 63% (95% CI: 52-75) in patients whose CD4 cell count at 6 months was <100 cells/microL and whose HIV-1 RNA concentration was >or=5 log10.


CONCLUSIONS
Plasma HIV-1 RNA concentration and CD4 cell count should be taken into account independently when evaluating early response to treatment. The persistent impact of early response on clinical progression at 5 years emphasizes the major importance of the success of first-line HAART.
Inserm U720, Faculté de médecine Pitié Salpetrière, Université Paris VI, and Service de Biostatistique et Informatique Médicale, Hôpital Cochin, Université Paris V, Paris, France. grabar@cochin.univ-paris5.fr
Sophie
S
Grabar
Vincent
V
Le Moing
Cécile
C
Goujard
Matthias
M
Egger
Catherine
C
Leport
Michel D
MD
Kazatchkine
Laurence
L
Weiss
Dominique
D
Costagliola
D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D016208:Databases, Factual; D005602:France; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D015497:HIV-1; D006801:Humans; D008954:Models, Biological; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012367:RNA, Viral / Q000097:blood; D013997:Time Factors
D012367:RNA, Viral