Article
Risk of new AIDS defining events in patients with advanced immunodeficiency during suppressive HAART: results from the German ClinSurv cohort
Risikoanalyse neuer AIDS Erkrankungen in Patienten mit schwerer erworbener Immundefizienz unter suppressiver ART: Resultate aus der ClinSuv Kohorte
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Authors
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A. Zoufaly
- Universitätsklinikum Hamburg-Eppendorf, 1. Medizinische Klinik, Hamburg, Germany
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C. Kreuzberg
- Universitätsklinikum Hamburg-Eppendorf, 1. Medizinische Klinik, Hamburg, Germany
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M. an der Heiden
- Robert Koch Institut, Berlin, Germany
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C. Kollan
- Robert Koch Institut, Berlin, Germany
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O. Hamouda
- Robert Koch Institut, Berlin, Germany
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J. van Lunzen
- Universitätsklinikum Hamburg-Eppendorf, 1. Medizinische Klinik / Ambulanzzentrum Infektiologie, Hamburg, Germany
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ClinSurv Studiengruppe
| Published: | June 2, 2010 |
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Outline
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Background: Despite recent advances in the reduction of morbidity and mortality after the advent of HAART, a large number of HIV patients still present late with advanced immunodeficiency. In these patients the risk of developing AIDS-defining events (ADE) may depend on a solid immune reconstitution with immune-discordant responses being at higher risk. We aimed to determine risk factors for the development of ADE in patients who begin fully suppressive antiretroviral treatment with CD4 counts <200 cells/µl.
Methods: Data of 1.576 treatment naive patients starting HAART after 1.1.1996 at a CD4 count <200 cells/µl were followed from the date of full viral suppression until virological failure, the occurrence of a new ADE, loss of follow-up or 31.12.2007 whichever occurred first. An adjusted Poisson regression model was used to analyze the incidence rate ratio (IRR) between immune-discordance (all CD4 counts <200 cells/µl) and immune-response (at least one CD4 count >200 cells/µl) in the first, second, and third year. In addition, a Cox model was fitted to analyze risk factors for a new ADE encompassing all available follow-up data.
Results: In the first year a total of 42 new ADE occurred with a IRR for immune-discordance of 5.57 (95%CI 2.96–10.48, p<0.001) in the adjusted Poisson model. In the second (9 events) and third year (8 events) of viral control a non-significant trend towards a lower influence of immune-discordance was observed (IRR 1.03, 95%CI 0.13–8.26, p=0.98 and 2.02, 95%CI 0.25–16.41, p=0.51, respectively). In the Cox model analyzing 3633 person years of follow up risk factors for development of a new ADE included the latest CD4 count below 50 cells/µl (HR 6.36,95%CI 2.53-15.95, p< 0.001) and CD4 counts between 50-100 cells/µl (HR 3.84,95%CI 1.70-8.68, p=0.001). No significant influence of latest CD4 count above 100 cells/µl, CD4 count at initiation of HAART, sex, age, transmission risk, and AIDS defining event prior to initiation of HAART was observed.
Conclusions: Immune-discordance is a risk factor for a new ADE while on HAART during the first year of suppressed viremia. After this time the incidence of ADE decreases dramatically even in patients with prolonged immunodeficiency. The risk is highest in patients who fail to increase CD4 counts to >100 cells/µl. Strategies to rise or maintain a CD4 count above at least 100 cells/µl could prevent most ADE in this patient group.
