Predictors of clinical progression among HIV-1-positive patients starting HAART with CD4+ T-cell counts > or =200 cells/mm3.
Antivir Ther. 2007; 12(6):941-7.AT

Abstract

BACKGROUND

Baseline and follow-up predictors of new AIDS-defining events (ADE) or death among patients who started HAART with CD4+ T-cell counts > or =200 cells/mm3 have rarely been assessed simultaneously.

METHODS

A prospective observational cohort study (1996-2002) is reported. HIV-infected patients initiating HAART with a CD4+ T-cell count > or =200 cells/mm3 were studied. Baseline and time-varying factors were tested for the prediction of new ADE/death using Cox regression models.

RESULTS

A total of 896 subjects were studied over a median of 5.1 years. The incidence of a new ADE was 1.6 (95% confidence interval 1.3-2.1) per 100 person-years. Among baseline factors, higher CD4+ T-cell counts before HAART were associated with lower risk of ADE/death, but not after adjustment for time-varying factors. On a multivariable analysis including both baseline and time-varying covariates, longer delay from HIV diagnosis to HAART was an independent predictor of ADE/death (per year, hazard ratio [HR] 1.06; P = 0.025) and was independent of CD4+ T-cell count before treatment. Longer time spent with HIV RNA <400 copies/ml (per month, HR 0.96; P = 0.003) and higher latest CD4+ T-cell count (per log2 cells/mm3, HR 0.65; P < 0.001) were found to be protective.

CONCLUSIONS

Patients with higher CD4+ T-cell counts before HAART initiation had a better prognosis. However, except for the delay in starting HAART, viroimmunological evolution outweighed the effect of baseline factors. Moreover, suppressing HIV replication for as long as possible could improve the clinical outcome. Prospective randomized clinical trials to assess the optimal timing of HAART initiation are both feasible and urgently needed.

Links

treatment guidelines

Authors+Show Affiliations

Lapadula G
Institute for Infectious and Tropical Diseases, University of Brescia, Italy.
Torti C
No affiliation info available
Maggiolo F
No affiliation info available
Casari S
No affiliation info available
Suter F
No affiliation info available
Minoli L
No affiliation info available
Pezzoli C
No affiliation info available
Di Pietro M
No affiliation info available
Migliorino G
No affiliation info available
Ouiros-Roldan E
No affiliation info available
Ladisa N
No affiliation info available
Sighinolfi L
No affiliation info available
Costarelli S
No affiliation info available
Carosi G
No affiliation info available
Italian MASTER Cohort
No affiliation info available

MeSH

AdultAnti-HIV AgentsAntiretroviral Therapy, Highly ActiveCD4 Lymphocyte CountCohort StudiesDisease ProgressionFemaleHIV InfectionsHIV-1HumansMalePrognosis

Pub Type(s)

Journal Article

Language

eng

PubMed ID

17926648