Patients presenting with AIDS in the HAART era: a collaborative cohort analysis.
OBJECTIVE
Many patients infected with HIV still present with an AIDS diagnosis. The aim of this study was to evaluate the virological, immunological and clinical outcomes of HAART in these patients.


METHODS
The present study was a multi-cohort study. All patients with an AIDS diagnosis between 30 days before and 14 days after HIV diagnosis, recruited between 1997 and 2004 from eight hospital cohorts, were evaluated.


RESULTS
A total of 760 patients were included [268 (35.3%) had pneumocystis and 168 (22.1%) tuberculosis]. Six hundred and twenty-four patients (82.1%) started HAART a median of 31 days after HIV diagnosis. One hundred and fifty-three patients started a nonnucleoside transcriptase inhibitor-based regimen (20.1%), 409 a protease inhibitor-based regimen (53.8%) and 62 other regimens (8.2%). In adjusted analyses, HAART was started sooner in more recent years, in patients with lower CD4 cell count and in those with Kaposi's sarcoma, whereas it was started later in those with tuberculosis. Five hundred and five patients (89%) attained a viral load of less than 500 copies/ml. The factors associated with a better virological response were later calendar year, lower initial viral load and cytomegalovirus disease. Virological rebound was more common in those receiving nucleoside reverse transcriptase inhibitor-based regimens, in those with tuberculosis and in earlier calendar years. One hundred and twenty-five (16%) patients died; 61 had received HAART (48.6%). Mortality was more likely in those who were older, those with a higher viral load at diagnosis, those with nonsexual HIV risks and those with lower CD4 cell count and haemoglobin levels over follow-up.


CONCLUSIONS
Virological suppression was achieved in most AIDS patients, though mortality remains high in these individuals.
Mussini
Cristina
C
Clinic of Infectious and Tropical Diseases, University of Modena and Reggio Emilia, Modena, and Azienda Policlinico, Modena, Italy. crimuss@unimo.it
Manzardo
Christian
C
Johnson
Margaret
M
Monforte
Antonella d'Arminio
Ad
Uberti-Foppa
Caterina
C
Antinori
Andrea
A
Gill
M John
MJ
Sighinolfi
Laura
L
Borghi
Vanni
V
Lazzarin
Adriano
A
Miró
José M
JM
Sabin
Caroline
C
D017088:AIDS-Related Opportunistic Infections / Q000276:immunology / Q000517:prevention & control / Q000821:virology; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count / Q000379:methods; D015331:Cohort Studies; D024882:Drug Resistance, Viral; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D015497:HIV-1; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D019562:Viral Load