Predictors of AIDS-defining events among advanced naïve patients after HAART.

HIV Clin Trials 2007 May-Jun;8(3):112-20

Institute for Infectious and Tropical Diseases, University of Brescia, Italy.

Background: Baseline and follow-up predictors of new AIDS-defining events or death (ADE/death) among patients who started HAART late in their disease history have rarely been assessed simultaneously.

Method: ADE and mortality rates were assessed using Cox regression analyses. Variables were tested for prediction of ADE/death within the first 3 months of therapy and from month 3, thereafter.

Results: 751 HIV-infected patients with <200 CD4+/mm(3) before HAART were followed for a median of 49 months. 207 new ADE occurred (7.06 [6.16-8.10] per 100 patient-years). ADE/deaths clustered within the first 3 months of treatment (106/207, 51%). Higher CD4+ T-cell counts during the follow-up (per log(e) cells/mm(3): hazard ratio [HR] 0.51; 0.41-0.64; p < .001) and use of antiretroviral therapy (HR 0.38; 95% CI 0.21-0.69; p = .001) appeared to protect from ADE/death after month 3. Conversely, increasing follow-up with HIV RNA >400 copies/mL correlated with ADE/death (per month: HR 1.09; 95% CI 1.06-1.12; p = .001). Use of boosted protease inhibitors as first-line HAART and HCV-seropositivity were additional risk factors. Baseline CD4+ T-cell count and HIV RNA had a predominant impact in the first 3 months after HAART initiation.

Conclusion: A careful monitoring of patients with low CD4+ is particularly necessary during the first few months of HAART. Length and extent of viral replication during the follow-up appeared to induce a significantly higher risk of HIV disease progression afterwards, implying that new drugs and new strategies aimed at ensuring long-term suppression of HIV RNA are of outstanding importance.

Download full-text PDF

Source
http://dx.doi.org/10.1310/hct0803-112DOI Listing
September 2007
12 Reads

Publication Analysis

Top Keywords

months haart
8
hiv rna
8
aids-defining events
8
predictors aids-defining
8
haart
5
ade/death month
4
correlated ade/death
4
copies/ml correlated
4
appeared induce
4
400 copies/ml
4
follow-up appeared
4
109 95%
4
106-112 001
4
viral replication
4
replication follow-up
4
95% 106-112
4
patients 400
4
month 109
4
induce higher
4
careful monitoring
4

References

(Supplied by CrossRef)

Egger M et al.
Lancet 2002

Chene G et al.
Lan-cet 2003

World Health Organization et al.
2004

Similar Publications