Fungal infection as a risk factor for HIV disease progression among patients with a CD4 count above 200/microl in the era of cART.
The identification of clinical risk factors for AIDS in patients with preserved immune function is of significant interest. We examined whether patients with fungal infection (FI) and CD4 cell count >or=200/microl were at higher risk of disease progression in the era of cART. 11,009 EuroSIDA patients were followed from their first CD4 cell count >or=200/microl after 1 January 1997 until progression to any non-azoles/amphotericin B susceptible (AAS) AIDS disease, last visit or death. Initiation of antimycotic therapy (AMT) was used as a marker of FI and was modelled as a time-updated covariate using Poisson regression. After adjustment for current CD4 cell count, HIV-RNA, starting cART and diagnosis of AAS-AIDS, AMT was significantly associated with an increased incidence of non-AAS-AIDS (IRR=1.55, 95% CI 1.17-2.06, p=0.0024). Despite low incidence of AIDS in the cART era, FI in patients with a CD4 cell count >or=200/microl is associated with a 55% higher risk of non-AAS-AIDS (95% confidence interval 1.17-2.06, p=0.0024). These data suggest that patients with FI are more immune compromized than would be expected from their CD4 cell count alone. FI can be used as a clinical marker for disease progression and indirect indicator for initiation/changing cART in settings where laboratory facilities are limited.
Podlekareva
Daria
D
Copenhagen HIV Programme, University of Copenhagen, Faculty of Health Sciences, Denmark. dpo@cphiv.dk
Mocroft
Amanda
A
Kirk
Ole
O
Reiss
Peter
P
Aldins
Pauls
P
Katlama
Christine
C
Kovari
Helen
H
Stellbrink
Hans-Juergen
HJ
D'Arminio Monforte
Antonella
A
Lundgren
Jens D
JD
D000328:Adult; D044966:Anti-Retroviral Agents / Q000008:administration & dosage* / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D018450:Disease Progression; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000150:complications* / Q000188:drug therapy; D011446:Prospective Studies; D012307:Risk Factors
D044966:Anti-Retroviral Agents; D000935:Antifungal Agents