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

The aim of this study was to analyse factors associated with progression to AIDS/death in severely immunosuppressed HIV-infected patients receiving ART. This study included naive patients from the PISCIS Cohort with CD4 18 years followed at 14 participating hospitals in Catalonia and the Balearic Is...

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Veröffentlicht in:Journal of antimicrobial chemotherapy 2015-12, Vol.70 (12), p.3332-3338
Hauptverfasser: Ferrer, Elena, Curto, Jordi, Esteve, Anna, Miro, Jose M, Tural, Cristina, Murillas, Javier, Segura, Ferran, Barrufet, Pilar, Casabona, Jordi, Podzamczer, Daniel
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Sprache:eng
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Zusammenfassung:The aim of this study was to analyse factors associated with progression to AIDS/death in severely immunosuppressed HIV-infected patients receiving ART. This study included naive patients from the PISCIS Cohort with CD4 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. 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). 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. 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.
ISSN:0305-7453
1460-2091
DOI:10.1093/jac/dkv272