Rate of AIDS diseases or death in HIV-infected antiretroviral therapy-naive individuals with high CD4 cell count.
OBJECTIVE
To assess the absolute rate of AIDS and death in antiretroviral therapy (ART)-naive patients with a high CD4 cell count. Such information would be helpful in the design of a trial investigating early initiation of ART.


METHODS
Analysis of data from an ongoing HIV cohort study.


METHODS
The rate of (severe) AIDS or death and death alone was evaluated in ART-naive patients according to the current CD4 cell count, focusing on CD4 cell counts > or = 350 cells/microl among patients in the UK CHIC Study.


RESULTS
In a total of 30 313 person-years of follow-up, there were 1557 AIDS or death events. The rate of AIDS or death in persons with most recent CD4 cell count 350-499, 500-649 and > 650 cells/microl was 2.49, 1.54 and 0.96 per 100 person-years, respectively. The rate ratio for those with CD4 cell count 500-649 cells/microl compared with those with CD4 cell count > or = 650 cells/microl was 1.55 [95% confidence interval (CI), 1.11-2.17; P = 0.01]. In a Poisson regression model based on person years with CD4 cell count > or = 350 cells/microl , there was a strong effect of CD4 cell count on rate of AIDS or death (rate ratio, 0.84; 95% CI, 0.76-0.93; P = 0.001), independent of viral load and age.


CONCLUSIONS
The trend of decreasing rate of AIDS and death with higher CD4 cell count is present throughout the CD4 cell count > or = 350 cells/microl range in ART-naive people.
Phillips
Andrew N
AN
Department of Primary Care and Population Sciences, Royal Free and University College Medical School, London, UK. a.phillips@pcps.ucl.ac.uk
Gazzard
Brian
B
Gilson
Richard
R
Easterbrook
Philippa
P
Johnson
Margaret
M
Walsh
John
J
Leen
Clifford
C
Fisher
Martin
M
Orkin
Chloe
C
Anderson
Jane
J
Pillay
Deenan
D
Delpech
Valerie
V
Sabin
Caroline
C
Schwenk
Achim
A
Dunn
David
D
Gompels
Mark
M
Hill
Teresa
T
Porter
Kholoud
K
Babiker
Abdel
A
D000163:Acquired Immunodeficiency Syndrome / Q000453:epidemiology* / Q000276:immunology / Q000635:transmission / Q000821:virology; D000328:Adult; D000367:Age Factors; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000276:immunology / Q000401:mortality / Q000635:transmission / Q000821:virology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012737:Sex Factors; D006113:United Kingdom / Q000453:epidemiology; D019562:Viral Load