title: Fatal and nonfatal AIDS and non-AIDS events in HIV-1-positive individuals with high CD4 cell counts according to viral load strata.
abstract: BACKGROUND
  This study compared the incidence of fatal and nonfatal AIDS and non-AIDS events in HIV-positive individuals with a CD4 cell count more than 350  cells/μl among viral load strata: low (<500  copies/ml), intermediate (500-9999.9  copies/ml) and high (≥ 10000  copies/ml).
  
  
  METHODS
  Individuals contributed person-years at risk if their most recent CD4 cell count was more than 350  cells/μl. Follow-up was censored if their CD4 cell count dropped below 350  cells/μl. Poisson regression analysis investigated the relationship between viraemia and the incidence of AIDS and non-AIDS events.
  
  
  RESULTS
  Three hundred and fifty-four AIDS events occurred during 51 732  person-years of follow-up (PYFU), crude incidence rate of AIDS across the three strata was 0.53, 0.90 and 2.12 per 100 PYFU, respectively. After adjustment, a higher rate of AIDS was observed in individuals with moderate [incidence rate ratio (IRR) 1.44, 1.02-2.05, P = 0.03] and high viraemia had a higher rate (IRR 3.91, 2.89-5.89, P < 0.0001) compared with low viraemia. Five hundred and seventy-two non-AIDS events occurred during 43 784 PYFU, the crude incidence rates were 1.28, 1.52, and 1.38 per 100 PYFU, respectively. After adjustment, particularly for age, region of Europe and starting combination antiretroviral therapy, there was a 61% (IRR 1.61, 1.21-2.14, P = 0.001) and 66% (IRR 1.66, 1.17-2.32, P = 0.004) higher rate of non-AIDS in individuals with intermediate and high viraemia compared with low viraemia.
  
  
  CONCLUSIONS
  In individuals with a CD4 cell count more than 350  cells/μl, an increased incidence of AIDS and a slightly increased incidence of non-AIDS was found in those with uncontrolled viral replication. The association with AIDS was clear and consistent. However, the association with non-AIDS was only apparent after adjustment and no differences were observed between intermediate and high viraemia.
authors.affiliation: University College London Medical School, London, UK. j.reekie@ucl.ac.uk
authors.forename: Joanne
authors.initials: J
authors.lastname: Reekie
authors.forename: Jose M
authors.initials: JM
authors.lastname: Gatell
authors.forename: Israel
authors.initials: I
authors.lastname: Yust
authors.forename: Elzbieta
authors.initials: E
authors.lastname: Bakowska
authors.forename: Aza
authors.initials: A
authors.lastname: Rakhmanova
authors.forename: Marcelo
authors.initials: M
authors.lastname: Losso
authors.forename: Maksym
authors.initials: M
authors.lastname: Krasnov
authors.forename: Patrick
authors.initials: P
authors.lastname: Francioli
authors.forename: Justyna D
authors.initials: JD
authors.lastname: Kowalska
authors.forename: Amanda
authors.initials: A
authors.lastname: Mocroft
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology* / Q000276:immunology; D000163:Acquired Immunodeficiency Syndrome / Q000276:immunology / Q000401:mortality*; D000328:Adult; D001118:Argentina / Q000453:epidemiology; D018791:CD4 Lymphocyte Count; D018450:Disease Progression; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000453:epidemiology / Q000276:immunology; D015497:HIV-1; D006801:Humans; D015994:Incidence; D007557:Israel / Q000453:epidemiology; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D019562:Viral Load; D014766:Viremia