Clinical progression of severely immunosuppressed HIV-infected patients depends on virological and immunological improvement irrespective of baseline status

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Abstract

Objectives

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/mm3 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/mm3, 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/mm3 and viral load <5 log copies/mL; 2.3% in baseline CD4 ≤100 cells/mm3 and/or viral load >5 log copies/mL). Achieving a CD4 count ≥200 cells/mm3 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/mm3 and high baseline viral loads, positive virological and immunological responses were associated with dramatic decreases in progression.

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