title: Fungal infection as a risk factor for HIV disease progression among patients with a CD4 count above 200/microl in the era of cART.
abstract: 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.
authors.affiliation: Copenhagen HIV Programme, University of Copenhagen, Faculty of Health Sciences, Denmark. dpo@cphiv.dk
authors.forename: Daria
authors.initials: D
authors.lastname: Podlekareva
authors.forename: Amanda
authors.initials: A
authors.lastname: Mocroft
authors.forename: Ole
authors.initials: O
authors.lastname: Kirk
authors.forename: Peter
authors.initials: P
authors.lastname: Reiss
authors.forename: Pauls
authors.initials: P
authors.lastname: Aldins
authors.forename: Christine
authors.initials: C
authors.lastname: Katlama
authors.forename: Helen
authors.initials: H
authors.lastname: Kovari
authors.forename: Hans-Juergen
authors.initials: HJ
authors.lastname: Stellbrink
authors.forename: Antonella
authors.initials: A
authors.lastname: D'Arminio Monforte
authors.forename: Jens D
authors.initials: JD
authors.lastname: Lundgren
mesh_terms: 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
chemical_list: D044966:Anti-Retroviral Agents; D000935:Antifungal Agents