title: Clinical progression of severely immunosuppressed HIV-infected patients depends on virological and immunological improvement irrespective of baseline status.
abstract: OBJECTIVE
  The aim of this study was to analyse factors associated with progression to AIDS/death in severely immunosuppressed HIV-infected patients receiving ART.
  
  
  METHODS
  This study included naive patients from the PISCIS Cohort with CD4 <200 cells/mm(3) at enrolment and who initiated ART consisting of two nucleoside analogues plus either a PI or an NNRTI between 1998 and 2011. The PISCIS Cohort is a multicentre, observational study of HIV-infected individuals aged >18 years followed at 14 participating hospitals in Catalonia and the Balearic Islands (Spain). Clinical and laboratory parameters were assessed every 3-4 months during follow-up. Cox regression models were used to assess the effect of CD4 and viral load on the risk of progression to AIDS/death, adjusting for baseline variables and confounders.
  
  
  RESULTS
  2295 patients were included and, after 5 years, 69.9% reached CD4 ≥200 cells/mm(3), 64.4% had an undetectable viral load and 482 (21%) progressed to AIDS/death. The lowest rate of disease progression was found in patients who reached both immunological and viral responses during follow-up, regardless of their baseline situation (1.9% in baseline CD4 >100 cells/mm(3) and viral load <5 log copies/mL; 2.3% in baseline CD4 ≤100 cells/mm(3) and/or viral load >5 log copies/mL). Achieving a CD4 count ≥200 cells/mm(3) was the main predictor of decreased progression to AIDS/death. In those not reaching this CD4 threshold, virological response reduced disease progression by half.
  
  
  CONCLUSIONS
  Even in the worse baseline scenario of CD4 ≤100 cells/mm(3) and high baseline viral loads, positive virological and immunological responses were associated with dramatic decreases in progression.
authors.affiliation: HIV Unit, Infectious Disease Service, Hospital Universitari de Bellvitge, L'Hospitalet del Llobregat, 08907 Barcelona, Spain eferrer@bellvitgehospital.cat.
authors.forename: Elena
authors.initials: E
authors.lastname: Ferrer
authors.affiliation: HIV Unit, Infectious Disease Service, Hospital Universitari de Bellvitge, L'Hospitalet del Llobregat, 08907 Barcelona, Spain Department of Public Health, Mental Health and Perinatal Nursing, University School of Nursing, Campus de Bellvitge-Pavelló de Govern, Feixa Llarga, s/n L'Hospitalet del Llobregat, 08907 Barcelona, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Curto
authors.affiliation: Centre for Epidemiological Studies on HIV/STI in Catalonia (CEEISCAT), Agencia de Salut Publica de Catalunya (ASPC), Generalitat de Catalunya, 08916 Badalona, Spain CIBER Epidemiología y Salud Pública (CIBERESP), 08036 Barcelona, Spain Fundació Institut d'Investigació Germans Trias i Pujol (IGTP), 08916 Badalona, Spain Department of Paediatrics, Obstetrics and Gynaecology, and Preventive Medicine, Universitat Autónoma de Barcelona, 08193 Bellaterra (Cerdanyola del Vallés), Spain.
authors.forename: Anna
authors.initials: A
authors.lastname: Esteve
authors.affiliation: Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Hospital Clinic, Villarroel, 170, 08036 Barcelona, Spain.
authors.forename: Jose M
authors.initials: JM
authors.lastname: Miro
authors.affiliation: Fundació Lluita contra la SIDA, Hospital Universitari Germans Trias i Pujol, 2a planta Maternal, Ctra. de Canyet s/n, 08916 Badalona, Barcelona, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Tural
authors.affiliation: Infectious Diseases Service, Hospital Son Dureta, C/ Andrea Doria, 55, 07014 Palma de Mallorca, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Murillas
authors.affiliation: Infectious Diseases Service, Corporació Sanitaria i Universitaria Parc Taulí, 08208 Sabadell, Universitat Autónoma de Barcelona, 08193 Bellaterra (Cerdanyola del Vallés), Spain.
authors.forename: Ferran
authors.initials: F
authors.lastname: Segura
authors.affiliation: Internal Medicine Unit, Hospital de Mataró, C/ Cirera sn. Mataró, 08304 Barcelona, Spain.
authors.forename: Pilar
authors.initials: P
authors.lastname: Barrufet
authors.affiliation: Centre for Epidemiological Studies on HIV/STI in Catalonia (CEEISCAT), Agencia de Salut Publica de Catalunya (ASPC), Generalitat de Catalunya, 08916 Badalona, Spain CIBER Epidemiología y Salud Pública (CIBERESP), 08036 Barcelona, Spain Fundació Institut d'Investigació Germans Trias i Pujol (IGTP), 08916 Badalona, Spain Department of Paediatrics, Obstetrics and Gynaecology, and Preventive Medicine, Universitat Autónoma de Barcelona, 08193 Bellaterra (Cerdanyola del Vallés), Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Casabona
authors.affiliation: HIV Unit, Infectious Disease Service, Hospital Universitari de Bellvitge, L'Hospitalet del Llobregat, 08907 Barcelona, Spain.
authors.forename: Daniel
authors.initials: D
authors.lastname: Podzamczer
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology*; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013030:Spain; D016019:Survival Analysis; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents