title: Increased risk of non-AIDS-related events in HIV subjects with persistent low CD4 counts despite cART in the CoRIS cohort.
abstract: The aim was to analyze clinical complications in HIV-infected subjects who persistently maintain low CD4 levels despite virological response to cART in the Spanish CoRIS cohort. The main inclusion criteria were CD4 counts <200cells/mm(3) at cART-initiation and at least 2years under cART achieving a viral load <500copies/mL. Those patients with CD4 counts <250cells/mm(3) 2years after cART were classified as the Low-CD4 group, and clinical events were collected from this time-point. Poisson regression models were used to calculate incidence rate ratios of death, AIDS-defining events, serious non-AIDS-defining events (NAE) and of each specific NAE category (non-AIDS-defining malignancies (non-ADM), cardiovascular, kidney- and liver-related events). Of 9667 patients in the cohort, a total of 1128 met the criteria and 287 (25.4%) were classified in the Low-CD4 group. A higher risk of death (aIRR: 4.71; 95% CI: 1.88-11.82; p-value=0.001) and of non-ADM were observed in this group (aIRR: 2.23; 95% CI: 1.07-4.63; p=0.03). Our results stress the need to control accelerated aging in this population to counter their increased risk of non-AIDS-defining diseases, particularly cancer, and are consistent with the concept that clinical complications are potentially affected by genetics and lifestyle.
authors.affiliation: Laboratory of Immunovirology, Clinic Unit of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville, IBiS, Virgen del Rocío University Hospital/CSIC/University of Seville, Seville 41013, Spain. Electronic address: ypacheco-ibis@us.es.
authors.forename: Y M
authors.initials: YM
authors.lastname: Pacheco
authors.affiliation: Institute of Health Carlos III, Madrid, Spain.
authors.forename: I
authors.initials: I
authors.lastname: Jarrin
authors.affiliation: Laboratory of Immunovirology, Clinic Unit of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville, IBiS, Virgen del Rocío University Hospital/CSIC/University of Seville, Seville 41013, Spain.
authors.forename: I
authors.initials: I
authors.lastname: Rosado
authors.affiliation: Hospital Universitari Son Espases, Palma de Mallorca, Spain.
authors.forename: A A
authors.initials: AA
authors.lastname: Campins
authors.affiliation: Infectious Diseases/HIV Unit, Gregorio Marañón General University Hospital, Madrid, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Berenguer
authors.affiliation: Hospital Universitario de Donostia, San Sebastián, Spain.
authors.forename: J A
authors.initials: JA
authors.lastname: Iribarren
authors.affiliation: Navarra Hospital, Pamplona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Rivero
authors.affiliation: Unidad de Enfermedades Infecciosas, Hospital Universitario San Cecilio, Granada, Spain.
authors.forename: L
authors.initials: L
authors.lastname: Muñoz-Medina
authors.affiliation: Servicio de Enfermedades Infecciosas, Hospital General Universitario Reina Sofia, Madrid, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Bernal-Morell
authors.affiliation: Infectious Diseases Unit, Hospital General Universitario de Elche, Clinical Medicine Department, Universidad Miguel Hernández, Alicante, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Gutiérrez
authors.affiliation: Laboratory of Immunovirology, Clinic Unit of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville, IBiS, Virgen del Rocío University Hospital/CSIC/University of Seville, Seville 41013, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Leal
mesh_terms: D000328:Adult; D000368:Aged; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D002318:Cardiovascular Diseases / Q000150:complications / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000276:immunology* / Q000821:virology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000453:epidemiology; D011446:Prospective Studies; D012044:Regression Analysis; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D013997:Time Factors; D019562:Viral Load; D055815:Young Adult
keywords: AIDS; Clinical complications; Immunodeficiency; Low-CD4 restoration; Mortality; Non-AIDS-defining events; Non-AIDS-defining malignancies