Norwegians ranked high with the SCORE total cholesterol model and Norwegian men low with the SCORE ratio model. Although the predictive accuracy of the SCORE models for immigrants in Norway remains to be evaluated, our findings suggest that the ratio model could be more applicable to the entire population in Norway.
Background
Random effects models were used to explore how the shape of CD4 cell count responses after commencing combination antiretroviral therapy (cART) develop over time, and in particular the role of baseline and follow-up covariates.
Methods
Patients in APHOD who first commenced cART after January 1, 1997, and who had a baseline CD4 cell count and viral load measure and at least one follow-up measure between 6 and 24 months, were included. CD4 cell counts were determined at every 6-month period following the commencement of cART for up to 6 years.
Results
1638 patients fulfilled the inclusion criteria with a median follow up time of 58 months. Lower post-cART mean CD4 cell counts were found to be associated with increasing age (p<0.001), pre-cART hepatitis C co-infection (p=0.038), prior AIDS (p=0.019), baseline viral load ≤ 100,000 copies/ml (p<0.001), and the Asia-Pacific region compared with Australia (p=0.005). A highly significant 3-way interaction between the effects of time, baseline CD4 cell count and post-cART viral burden (p<0.0001) was demonstrated. Higher long-term mean CD4 cell counts were associated with lower baseline CD4 cell count and consistently undetectable viral loads. Among patients with consistently detectable viral load CD4 cell counts appeared to converge for all baseline CD4 levels.
Conclusion
Our analyses suggest that the long-term shape of post-cART CD4 cell count changes depends only on a 3-way interaction between baseline CD4 cell count, viral load response and time.
Objectives
To determine the prevalence and predictors of an incomplete immune response in patients with sustained viral suppression following their first or second combination antiretroviral treatment (cART) regimen.
Methods
All patients were recruited to the Australian HIV Observational Database (AHOD) by March 2006. Data were analysed to assess the prevalence of an incomplete immune response (<350 cells/μL) in the 12-24 months after starting the first or second cART regimen. Factors associated with an incomplete immune response were assessed using logistic regression and time to AIDS/death was assessed using survival analysis.
Results
Of the 2493 patients recruited to AHOD by March 2006, 590 were eligible for the analysis. Twenty eight percent of patients with a baseline CD4 count <350 cells/μL had an incomplete immune response 12-24 months after starting their first or second cART regimen. Lower baseline CD4 count prior to starting the cART regimen was predictive of an incomplete immune response. There was a non-significant trend towards faster AIDS or death in incomplete immune responders.
Conclusions
An incomplete immune response in patients with sustained viral suppression is associated with poorer immune function prior to starting cART. Type of cART or individual antiretroviral drugs was not associated with an incomplete immune response.
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