title: Rate and predictors of non-AIDS events in a cohort of HIV-infected patients with a CD4 T cell count above 500 cells/mm³.
abstract: The reduction of risk of non-AIDS events after combined antiretroviral therapy (cART) initiation and the crude incidence rate (CIR) of these events in patients who control the viral load without cART (controllers) in a cohort of 574 antiretroviral-naive patients with a baseline CD4 T cell count above 500 cells/mm³ were assessed. Non-AIDS severe events were defined as a first admission to the hospital due to non-AIDS-defining malignancies, cardiovascular, neuropsychiatric, liver-related, or end-stage renal disease events. Potential determinants of non-AIDS/death events were studied using Cox regression models. Eighty-five non-AIDS/death events occurred during 6,062 persons-years of follow-up (PYFU) with a CIR of 1.4 per 100 PYFU. Factors associated with non-AIDS/death event were age (HR 3.4; 95% CI: 1.6-6.9), nadir CD4 below 350 cells/mm³ (HR 2.5; 95% CI: 1.4-4.6), and a last determination of viral load above the median (HR 1.9; 95% CI: 1.0-3.3). The CIR of non-AIDS/death events was 2.1 and 1.8 per 100 PYFU before and after cART in patients who started cART (n=446). A reduction of CIR of non-AIDS events after cART initiation was observed only in patients with a nadir of CD4 above 350 cells/mm³ (2.5 vs. 0.6 per 100 PYFU, p=0.004, and remained stable after cART in patients with a median nadir of CD4 below 350 cells/mm³. CIR was similar in elite, viremic, and noncontrollers (1.1, 1.0, and 1.5 per 100 PYFU, respectively, p=0.25). Reduction of CIR of non-AIDS events after cART initiation depends on nadir CD4 T cell count. Most of the controllers patients had a CIR similar to noncontrollers. These data support the early initiation of cART in HIV-infected patients.
authors.affiliation: Hospital Clinic, University of Barcelona, IDIBAPS, Barcelona, Spain.
authors.forename: Constanza
authors.initials: C
authors.lastname: Lucero
authors.forename: Berta
authors.initials: B
authors.lastname: Torres
authors.forename: Agathe
authors.initials: A
authors.lastname: León
authors.forename: Marta
authors.initials: M
authors.lastname: Calvo
authors.forename: Lorna
authors.initials: L
authors.lastname: Leal
authors.forename: Iñaki
authors.initials: I
authors.lastname: Pérez
authors.forename: Montserrat
authors.initials: M
authors.lastname: Plana
authors.forename: Mireia
authors.initials: M
authors.lastname: Arnedo
authors.forename: Josep
authors.initials: J
authors.lastname: Mallolas
authors.forename: Josep M
authors.initials: JM
authors.lastname: Gatell
authors.forename: Felipe
authors.initials: F
authors.lastname: García
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000150:complications* / Q000453:epidemiology* / Q000821:virology; D000328:Adult; D018791:CD4 Lymphocyte Count; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013030:Spain; D015996:Survival Rate; D019562:Viral Load