Predictors of AIDS-defining events among advanced naïve patients after HAART.
BACKGROUND
Baseline and follow-up predictors of new AIDS-defining events or death (ADE/death) among patients who started HAART late in their disease history have rarely been assessed simultaneously.


METHODS
ADE and mortality rates were assessed using Cox regression analyses. Variables were tested for prediction of ADE/death within the first 3 months of therapy and from month 3, thereafter.


RESULTS
751 HIV-infected patients with <200 CD4+/mm(3) before HAART were followed for a median of 49 months. 207 new ADE occurred (7.06 [6.16-8.10] per 100 patient-years). ADE/deaths clustered within the first 3 months of treatment (106/207, 51%). Higher CD4+ T-cell counts during the follow-up (per log(e) cells/mm(3): hazard ratio [HR] 0.51; 0.41-0.64; p < .001) and use of antiretroviral therapy (HR 0.38; 95% CI 0.21-0.69; p = .001) appeared to protect from ADE/death after month 3. Conversely, increasing follow-up with HIV RNA >400 copies/mL correlated with ADE/death (per month: HR 1.09; 95% CI 1.06-1.12; p = .001). Use of boosted protease inhibitors as first-line HAART and HCV-seropositivity were additional risk factors. Baseline CD4+ T-cell count and HIV RNA had a predominant impact in the first 3 months after HAART initiation.


CONCLUSIONS
A careful monitoring of patients with low CD4+ is particularly necessary during the first few months of HAART. Length and extent of viral replication during the follow-up appeared to induce a significantly higher risk of HIV disease progression afterwards, implying that new drugs and new strategies aimed at ensuring long-term suppression of HIV RNA are of outstanding importance.
Torti
Carlo
C
Institute for Infectious and Tropical Diseases, University of Brescia, Italy. torti.carlo@libero.it
Lapadula
Giuseppe
G
Maggiolo
Franco
F
Casari
Salvatore
S
Suter
Fredy
F
Minoli
Lorenzo
L
Pezzoli
Chiara
C
Pietro
Massimo Di
MD
Migliorino
Guglielmo
G
Quiros-Roldan
Eugenia
E
Ladisa
Nicoletta
N
Sighinolfi
Laura
L
Gatti
Francesca
F
Carosi
Giampiero
G
D000163:Acquired Immunodeficiency Syndrome / Q000150:complications / Q000188:drug therapy* / Q000401:mortality*; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D018450:Disease Progression; D005260:Female; D006526:Hepatitis C / Q000150:complications; D006801:Humans; D008297:Male; D012367:RNA, Viral / Q000097:blood; D012307:Risk Factors; D016896:Treatment Outcome; D019562:Viral Load
D019380:Anti-HIV Agents; D012367:RNA, Viral