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Clinical outcome of HIV-infected antiretroviral-naive patients with discordant immunologic and virologic responses to highly active antiretroviral therapy.
J Acquir Immune Defic Syndr 2008; 47(5):553-8JA

Abstract

BACKGROUND

The prognostic significance of a response to highly active antiretroviral therapy (HAART) that is immunologically and virologically discordant is not well understood.

METHODS

Four hundred four antiretroviral-naive patients initiating HAART at an urban HIV outpatient clinic in 1995 to 2004 were analyzed. The association of treatment responses at 3 to 9 months after HAART initiation with time to development of an opportunistic infection (OI) or death was determined using Cox proportional hazards modeling. Logistic regression modeling was used to examine the association between discordant responses and patient characteristics.

RESULTS

Of 404 patients, 70.5% experienced favorable concordant responses (CD4 cell count [CD4]+/viral load [VL]+: increase in CD4 count of >or=50 cells/microL and achievement of undetectable plasma HIV RNA level), 15.8% an immunologic response only (CD4+/VL(-)), 8.7% a virologic response only (CD4(-)/VL+), and 5.0% a concordant unfavorable response (CD4(-)/VL(-)). Both types of discordant responses (CD4+/VL(-) and CD4(-)/VL+), nonresponse (CD4(-)/VL(-)), and baseline CD4 cell count were significantly associated with earlier development of an OI or death (relative hazard [RH] = 2.81, 95% confidence interval [CI]: 1.31 to 3.97; RH = 4.83, 95% CI: 2.10 to 11.12; and RH = 0.93, 95% CI: 0.88 to 0.99, respectively). CD4+/VL(-) and CD4(-)/VL(-) were associated with nonwhite race in multivariate logistic regression models (adjusted OR = 2.83, 95% CI: 1.46 to 5.47 and adjusted OR = 6.50, 95% CI: 1.65 to 25.69, respectively).

CONCLUSION

Discordant immunologic and virologic responses at 3 to 9 months after HAART initiation play important roles in predicting long-term clinical outcomes in treatment-naive patients.

Authors+Show Affiliations

Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL 35294-0022, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18285713

Citation

Tan, Ruimin, et al. "Clinical Outcome of HIV-infected Antiretroviral-naive Patients With Discordant Immunologic and Virologic Responses to Highly Active Antiretroviral Therapy." Journal of Acquired Immune Deficiency Syndromes (1999), vol. 47, no. 5, 2008, pp. 553-8.
Tan R, Westfall AO, Willig JH, et al. Clinical outcome of HIV-infected antiretroviral-naive patients with discordant immunologic and virologic responses to highly active antiretroviral therapy. J Acquir Immune Defic Syndr. 2008;47(5):553-8.
Tan, R., Westfall, A. O., Willig, J. H., Mugavero, M. J., Saag, M. S., Kaslow, R. A., & Kempf, M. C. (2008). Clinical outcome of HIV-infected antiretroviral-naive patients with discordant immunologic and virologic responses to highly active antiretroviral therapy. Journal of Acquired Immune Deficiency Syndromes (1999), 47(5), pp. 553-8. doi:10.1097/QAI.0b013e31816856c5.
Tan R, et al. Clinical Outcome of HIV-infected Antiretroviral-naive Patients With Discordant Immunologic and Virologic Responses to Highly Active Antiretroviral Therapy. J Acquir Immune Defic Syndr. 2008 Apr 15;47(5):553-8. PubMed PMID: 18285713.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical outcome of HIV-infected antiretroviral-naive patients with discordant immunologic and virologic responses to highly active antiretroviral therapy. AU - Tan,Ruimin, AU - Westfall,Andrew O, AU - Willig,James H, AU - Mugavero,Michael J, AU - Saag,Michael S, AU - Kaslow,Richard A, AU - Kempf,Mirjam C, PY - 2008/2/21/pubmed PY - 2008/6/24/medline PY - 2008/2/21/entrez SP - 553 EP - 8 JF - Journal of acquired immune deficiency syndromes (1999) JO - J. Acquir. Immune Defic. Syndr. VL - 47 IS - 5 N2 - BACKGROUND: The prognostic significance of a response to highly active antiretroviral therapy (HAART) that is immunologically and virologically discordant is not well understood. METHODS: Four hundred four antiretroviral-naive patients initiating HAART at an urban HIV outpatient clinic in 1995 to 2004 were analyzed. The association of treatment responses at 3 to 9 months after HAART initiation with time to development of an opportunistic infection (OI) or death was determined using Cox proportional hazards modeling. Logistic regression modeling was used to examine the association between discordant responses and patient characteristics. RESULTS: Of 404 patients, 70.5% experienced favorable concordant responses (CD4 cell count [CD4]+/viral load [VL]+: increase in CD4 count of >or=50 cells/microL and achievement of undetectable plasma HIV RNA level), 15.8% an immunologic response only (CD4+/VL(-)), 8.7% a virologic response only (CD4(-)/VL+), and 5.0% a concordant unfavorable response (CD4(-)/VL(-)). Both types of discordant responses (CD4+/VL(-) and CD4(-)/VL+), nonresponse (CD4(-)/VL(-)), and baseline CD4 cell count were significantly associated with earlier development of an OI or death (relative hazard [RH] = 2.81, 95% confidence interval [CI]: 1.31 to 3.97; RH = 4.83, 95% CI: 2.10 to 11.12; and RH = 0.93, 95% CI: 0.88 to 0.99, respectively). CD4+/VL(-) and CD4(-)/VL(-) were associated with nonwhite race in multivariate logistic regression models (adjusted OR = 2.83, 95% CI: 1.46 to 5.47 and adjusted OR = 6.50, 95% CI: 1.65 to 25.69, respectively). CONCLUSION: Discordant immunologic and virologic responses at 3 to 9 months after HAART initiation play important roles in predicting long-term clinical outcomes in treatment-naive patients. SN - 1525-4135 UR - https://www.unboundmedicine.com/medline/citation/18285713/Clinical_outcome_of_HIV_infected_antiretroviral_naive_patients_with_discordant_immunologic_and_virologic_responses_to_highly_active_antiretroviral_therapy_ L2 - http://Insights.ovid.com/pubmed?pmid=18285713 DB - PRIME DP - Unbound Medicine ER -