[Impact of baseline CD4 count, immune recovery and viral suppression at 7 year of first highly active antiretroviral therapy on survival, AIDS defining events and immune recovery reactions].
BACKGROUND
Baseline (BL) CD4 cell count is a major factor in outcome of highly active antiretroviral therapy (HAART); treatment induced immune recovery and viral response can modulate this outcome.


OBJECTIVE
To evaluate the association between baseline CD4 cell count and outcome during the first HAART regimen.


METHODS
Prospective study in 2,050 patients on first HAART with a follow up (f/u) ofat least 1 year. All had BL CD4 and viral load (VL) counts which were repeated at least twice a year. Patients were grouped according to BL CD4 (cells/mm(3)) in <100 (Gl), 100-199 (G2) and > or = (G3). Groups were further divided according to immune and virological response at 1 year in CD4 > or < 200 and VL detectable or undetectable (<80 copies/mL). Outcome measures were death, ALUS defining events (ADE) and, as a surrogate marker of immune recovery reaction, herpes zoster (HZ).


RESULTS
During the first year of follow up, 113 patients (10.8%) died in Gl (n =1,044), 17 (2.5%) in G2 (n =675) (Gl-2 p <0.05) and 9 (2.7%) in G3 (n =331) (G2-3 p NS). One hundred twenty five of 919 (13.6%) patients alive at 1 year had ADE in Gl, 55/643 (8.5%) in G2 (p <0.05) and 20/320 (5.2%) in G3 (G2-3 p NS). ADEs with follow up CD4 >vs< 200 were: 25/274 (9.1%) vs 100/643 (15 7%) in Gl (p <0.005); 28/404 (6.9%) vs 27/235 (11.2%) in G2 (p NS) and 18/281 (6.4%) vs 2/41 (4.8%) in G3 respectively (p NS). Detectable VL was an additional risk for ADE only in Gl without CD4 recovery. HZ was seen in 6.6% of Gl vs 4% in G2 (p <0.05) and 4.3% in G3. HZ rate was higher in all groups reaching a follow up CD4 >200 than those who did not, with a statistically significant difference at p <0.05 only in Gl (9.5% vs 5.3%).


CONCLUSIONS
The occurrence of death and ADE during the first year of HAART was significantly higher in patients with aBL CD4 <100, but no statistically significant difference was observed from BL CD4 >100 upwards. Immune recovery during f/u in the more immunosuppressed group greatly improved the outcome. The group with lowest BL CD4 and greater immune recovery showed the highest rate of immune recovery reaction.
Cortés
Claudia
C
Grupo SIDA Chile. ccortes@sidachile.cl
Beltrán
Carlos
C
Muñoz
Rodrigo
R
Daube
Elizabeth
E
Wolff
Marcelo
M
D017088:AIDS-Related Opportunistic Infections / Q000276:immunology / Q000517:prevention & control; D023241:Antiretroviral Therapy, Highly Active / Q000401:mortality; D018791:CD4 Lymphocyte Count; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy / Q000276:immunology / Q000401:mortality; D006801:Humans; D011446:Prospective Studies; D019562:Viral Load / Q000187:drug effects*