Clinical outcome of HIV-infected patients with sustained virologic response to antiretroviral therapy: long-term follow-up of a multicenter cohort.
BACKGROUND
Limited information exists on long-term prognosis of patients with sustained virologic response to antiretroviral therapy. We aimed to assess predictors of unfavorable clinical outcome in patients who maintain viral suppression with HAART.


METHODS
Using data collected from ten clinic-based cohorts in Spain, we selected all antiretroviral-naive adults who initiated HAART and maintained plasma HIV-1 RNA levels <500 copies/mL throughout follow-up. Factors associated with disease progression were determined by Cox proportional-hazards models.


RESULTS
Of 2,613 patients who started HAART, 757 fulfilled the inclusion criteria. 61% of them initiated a protease inhibitor-based HAART regimen, 29.7% a nonnucleoside reverse-transcriptase inhibitor-based regimen, and 7.8% a triple-nucleoside regimen. During 2,556 person-years of follow-up, 22 (2.9%) patients died (mortality rate 0.86 per 100 person-years), and 40 (5.3%) died or developed a new AIDS-defining event. The most common causes of death were neoplasias and liver failure. Mortality was independently associated with a CD4-T cell response <50 cells/L after 12 months of HAART (adjusted hazard ratio [AHR], 4.26 [95% confidence interval {CI}, 1.68-10.83]; P = .002), and age at initiation of HAART (AHR, 1.06 per year; 95% CI, 1.02-1.09; P = .001). Initial antiretroviral regimen chosen was not associated with different risk of clinical progression.


CONCLUSIONS
Patients with sustained virologic response on HAART have a low mortality rate over time. Long-term outcome of these patients is driven by immunologic response at the end of the first year of therapy and age at the time of HAART initiation, but not by the initial antiretroviral regimen selected.
Gutierrez
Félix
F
Unidad de Enfermedades Infecciosas, Hospital General Universitario de Elche, Universidad Miguel Hernández, Alicante, Spain. gutierrez_fel@gva.es
Padilla
Sergio
S
Masiá
Mar
M
Iribarren
José A
JA
Moreno
Santiago
S
Viciana
Pompeyo
P
Muñoz
Leopoldo
L
Gómez Sirvent
José L
JL
Vidal
Francesc
F
López-Aldeguer
José
J
Blanco
José R
JR
Leal
Manuel
M
Rodríguez-Arenas
María Angeles
MA
Perez Hoyos
Santiago
S
D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000401:mortality / Q000821:virology*; D015497:HIV-1 / Q000235:genetics / Q000302:isolation & purification; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D011379:Prognosis; D016016:Proportional Hazards Models; D012367:RNA, Viral / Q000097:blood; D013030:Spain / Q000453:epidemiology; D016896:Treatment Outcome
D012367:RNA, Viral