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 [6.16-8.101 per 100 patientyears). ADE/deaths clustered within the first 3 months of treatment (106/207, 51 %). Higher CD4+ T-cell counts during the follow-up (per log(8) cells/mm(3) : hazard ratio [HR] 0.51; 0.41-0.64; p <.001) and use of antiretroviral therapy (HR 0.38; 95% Cl 0.21-0.69; p =.001) appeared to protect from ADE/cleath after month 3. Conversely, increasing follow-up with HIV RNA >400 copies/mL correlated with ADE/cleath (per month: HR 1.09; 95% Cl 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.
Predictors of AIDS-defining events among advanced naïve patients after HAART.
Torti C;
2007-01-01
Abstract
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 [6.16-8.101 per 100 patientyears). ADE/deaths clustered within the first 3 months of treatment (106/207, 51 %). Higher CD4+ T-cell counts during the follow-up (per log(8) cells/mm(3) : hazard ratio [HR] 0.51; 0.41-0.64; p <.001) and use of antiretroviral therapy (HR 0.38; 95% Cl 0.21-0.69; p =.001) appeared to protect from ADE/cleath after month 3. Conversely, increasing follow-up with HIV RNA >400 copies/mL correlated with ADE/cleath (per month: HR 1.09; 95% Cl 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.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
