title: Response to HAART in treatment-naive HIV-infected patients with a prior diagnosis of tuberculosis or other opportunistic infections.
abstract: We aimed to evaluate immunological, virological and clinical response to HAART, as well as all-cause mortality, in treatment-naive patients with a diagnosis of tuberculosis (TB) in the prior 6 months, compared to subjects with another AIDS-defining illness (ADI) or event-free individuals in an open, prospective and multicenter hospital-based cohort of HIV-infected naive adults (2004-2008). All cause mortality rates were calculated by Cox regression models. Among 4407 patients, 2400 (54.5%) started HAART: 110 (4.6%) had had previous TB and 414 (17.3%) another ADI. Median time from TB diagnosis to inititation of HAART was 53 days (IQR: 25.75-83.25), and for other ADI was 22 days (IQR: 8-42). Overall, 151 (6.3%) patients developed a new ADI during follow-up; 63% reached virological suppression and 69.4% had increases of ≥50 CD4+/µl, at 6 months. No statistically significant differences were found according to a previous history of TB or another ADI. Overall, 85 subjects died in 4031 person-years of follow-up with a mortality rate of 2.1 (95%CI: 1.7-2.6). When compared to subjects who started HAART in the absence of a previous ADI (HR 1), a prior diagnosis of an ADI other than TB was significantly associated with an increased risk of death. (HR 1.6; 95%CI: 1.1-2.3), but not a diagnosis of TB (HR 1.15; 95%CI: 0.5-2.5). In conclusion, a previous diagnosis of TB or another ADI before HAART did not compromise short-term virological and immunological response to treatment. A prior diagnosis of an ADI different to TB significantly increased all cause mortality.
authors.affiliation: Servicio de Enfermedades Infecciosas, Hospital Ramón y Cajal, Carretera de Colmenar, Madrid, Spain. fdronda.hrc@salud.madrid.org
authors.forename: Fernando
authors.initials: F
authors.lastname: Dronda
authors.forename: Paz
authors.initials: P
authors.lastname: Sobrino
authors.forename: Beatriz
authors.initials: B
authors.lastname: Hernández-Novoa
authors.forename: Ana M
authors.initials: AM
authors.lastname: Caro-Murillo
authors.forename: Marta
authors.initials: M
authors.lastname: Montero
authors.forename: José A
authors.initials: JA
authors.lastname: Iribarren
authors.forename: Jesús
authors.initials: J
authors.lastname: Sanz
authors.forename: María
authors.initials: M
authors.lastname: Del Mar Alonso
authors.forename: Pablo
authors.initials: P
authors.lastname: Labarga
authors.forename: Enrique
authors.initials: E
authors.lastname: Bernal
authors.forename: Santiago
authors.initials: S
authors.lastname: Moreno
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis* / Q000276:immunology / Q000401:mortality; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000401:mortality / Q000821:virology; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000276:immunology / Q000401:mortality; D019562:Viral Load; D055815:Young Adult