title: Long-term complications in patients with poor immunological recovery despite virological successful HAART in Dutch ATHENA cohort.
abstract: OBJECTIVE
  We investigated the risk of AIDS and serious non-AIDS-defining diseases (non-ADDs) according to the degree of immunological recovery after 2 years of virological successful antiretroviral therapy (HAART).
  
  
  METHODS
  Retrospective observational cohort study including HIV-infected patients treated with HAART resulting in viral suppression (<500 copies/ml).
  
  
  METHODS
  Patients were grouped according to their CD4 cell count after 2 years of HAART: CD4 cell count less than 200 cells/μl (group A), 200-350 cells/μl (group B), 351-500 cells/μl (group C) or more than 500 cells/μl (group D). Analysis was done to assess predictors for poor immunological recovery and the occurrence of a composite endpoint [death, AIDS, malignancies, liver cirrhosis and cardiovascular events (CVEs)], non-ADDs, CVEs and non-AIDS-defining malignancies (non-ADMs).
  
  
  RESULTS
  Three thousand and sixty-eight patients were included. Older age, lower CD4 cell nadir and lower plasma HIV-RNA at the start of HAART were independent predictors for a poor immunological recovery. The composite endpoint, non-ADDs and CVE were observed most frequently in group A (overall log rank, P < 0.0001, P = 0.002 and P = 0.01). In adjusted analyses, age was a strong independent predictor for all endpoints. Compared with group A, patients in group D had a lower risk for the composite endpoint [hazard ratio 0.54 (95% confidence interval [CI] 0.33-0.87]; patients in group B had a lower risk for CVEs [hazard ratio 0.34 (95% CI 0.14-0.86)].
  
  
  CONCLUSIONS
  Poor immunological recovery despite virological successful HAART is associated with a higher risk for overall morbidity and mortality and CVEs in particular. This study underlines the importance of starting HAART at higher CD4 cell counts, particularly in older patients.
authors: Department of Internal Medicine & Infectious Diseases, University Medical Center Utrecht, The Netherlands. s.f.l.vanlelyveld@umcutrecht.nl
authors: Steven F L
authors: SF
authors: van Lelyveld
authors: Luuk
authors: L
authors: Gras
authors: Anouk
authors: A
authors: Kesselring
authors: Shuangjie
authors: S
authors: Zhang
authors: Frank
authors: F
authors: De Wolf
authors: Annemarie M J
authors: AM
authors: Wensing
authors: Andy I M
authors: AI
authors: Hoepelman
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000150:complications / Q000276:immunology* / Q000401:mortality; D000328:Adult; D000367:Age Factors; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D002318:Cardiovascular Diseases / Q000209:etiology / Q000276:immunology* / Q000401:mortality; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000209:etiology / Q000276:immunology* / Q000401:mortality; D009426:Netherlands / Q000453:epidemiology; D012367:RNA, Viral / Q000187:drug effects; D012189:Retrospective Studies; D016896:Treatment Outcome; D019562:Viral Load / Q000187:drug effects*
chemical_list: D012367:RNA, Viral