Prognosis of patients treated with cART from 36 months after initiation, according to current and previous CD4 cell count and plasma HIV-1 RNA measurements.
OBJECTIVE
CD4 cell count and plasma viral load are well known predictors of AIDS and mortality in HIV-1-infected patients treated with combination antiretroviral therapy (cART). This study investigated, in patients treated for at least 3 years, the respective prognostic importance of values measured at cART initiation, and 6 and 36 months later, for AIDS and death.


METHODS
Patients from 15 HIV cohorts included in the ART Cohort Collaboration, aged at least 16 years, antiretroviral-naive when they started cART and followed for at least 36 months after start of cART were eligible.


RESULTS
Among 14 208 patients, the median CD4 cell counts at 0, 6 and 36 months were 210, 320 and 450 cells/microl, respectively, and 78% of patients achieved viral load less than 500 copies/ml at 6 months. In models adjusted for characteristics at cART initiation and for values at all time points, values at 36 months were the strongest predictors of subsequent rates of AIDS and death. Although CD4 cell count and viral load at cART initiation were no longer prognostic of AIDS or of death after 36 months, viral load at 6 months and change in CD4 cell count from 6 to 36 months were prognostic for rates of AIDS from 36 months.


CONCLUSIONS
Although current values of CD4 cell count and HIV-1 RNA are the most important prognostic factors for subsequent AIDS and death rates in HIV-1-infected patients treated with cART, changes in CD4 cell count from 6 to 36 months and the value of 6-month HIV-1 RNA are also prognostic for AIDS.
Emilie
E
Lanoy
Margaret
M
May
Amanda
A
Mocroft
Andrew
A
Phillip
Amy
A
Justice
Geneviève
G
Chêne
Hansjakob
H
Furrer
Timothy
T
Sterling
Antonella D'Arminio
AD
Monforte
Lluís
L
Force
John
J
Gill
Ross
R
Harris
Robert S
RS
Hogg
Jürgen
J
Rockstroh
Mike
M
Saag
Pavel
P
Khaykin
Frank
F
de Wolf
Jonathan A C
JA
Sterne
Dominique
D
Costagliola
D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D018450:Disease Progression; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000401:mortality* / Q000821:virology; D015497:HIV-1; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012367:RNA, Viral; D012307:Risk Factors; D013997:Time Factors; D019562:Viral Load; D055815:Young Adult
D019380:Anti-HIV Agents; D012367:RNA, Viral