Determinants of clinical progression in antiretroviral‐naïve HIV‐infected patients starting highly active antiretroviral therapy. Aquitaine Cohort, France, 1996–2002

Abstract

To determine the factors associated with clinical progression (AIDS events and death) in antiretroviral-naïve patients who have begun highly active antiretroviral therapy (HAART). MethodsHIV-infected patients naïve to antiretroviral therapy were included in a prospective hospital-based cohort who began HAART between June 1996 and December 2001. Progression was explained by baseline characteristics using Cox proportional hazards models. ResultsOverall, data for 709 patients were analysed. In multivariate analysis, factors associated with an increased risk of progression were CD4 count o50 cells/mL [hazard ratio (HR) 5 13.0 (95% confidence interval 3.8-44.3)] and between 50 and 199 cells/mL [HR 5 5.1 (1.6-16.3)], when compared with patients with CD4 count4350 cells/mL; AIDS events before HAART prescription [HR 5 2.1 (1.2-3.7)]; CD8 count o 400 cells/mL [HR 5 1.8 (1.1-3.0)]; and older age (HR 5 1.2 by 10 years (1.0-1.5)]. In a second model including CD4 percentage, factors associated with progression were CD4o10% [HR 5 6.3 (2.2-17.9)] and 10%oCD4 o15% [HR 5 4.2 (1.4-12.5)], when compared with patients with CD4420%; CD8 count; AIDS events before HAART prescription; and older age. In a third model including the CD4:CD8 ratio, factors associated with progression were CD4:CD8o15% [HR 5 8.2 (2.3-28.8)] and 15%oCD4:CD8o30% [HR 5 4.6 (1.3-16.0)], when compared with patients with CD4:CD8445%; AIDS events before HAART prescription; and older age. The Akaike information criteria for model analysis were 803, 805 and 815, respectively. ConclusionsConsideration of CD4 level in terms of CD4:CD8 ratio or CD4 percentage can be a good alternative to absolute CD4 count. Other prognostic factors such as older age, CD8 count o400 cells/mL and AIDS events also have to be considered in the decision to initiate HAART.

Long-Term Effectiveness of First-Line Antiretroviral Theraphy in a Cohort of HIV-1 Infected Patients

“…An analysis of multisite cohort collaborations may be useful to evaluate this point. Nevertheless, demographic and clinical characteristics of patients at baseline are similar to that reported in other studies conducted in Spain [39] and the South of Europe [40].…”

Age-Related Changes in Plasma Concentrations of the HIV Protease Inhibitor Lopinavir

“…12 Patients who are older at seroconversion and at initiation of HAART experience faster clinical disease progression than those who are younger. 13,14 Individuals who seroconvert at an older age appear to have higher HIV RNA concentrations. 15 Age-related changes in pharmacokinetics have not been well studied in this population.…”

Early antiretroviral therapy: the role of cohorts

“…Whereas investigators from the Johns Hopkins HIV Clinic Cohort [67,68] argued that similar clinical disease rates among those initiating HAART with CD4 cell counts of 201-350 and more than 350 cells/ml meant that there was no added value to starting HAART in the higher CD4 cell count range, Palella et al [69] reported that survival benefits would be possible if HAART was initiated at this level. In a French study, clinical progression rates were halved in those starting HAART with CD4 cell counts at least 350 cells/ml, compared to those starting at lower CD4 cell counts [70]. Among participants in the ALIVE cohort [71], survival of HAART-treated patients approximated that of HIV-seronegative participants only if treatment was initiated at CD4 cell counts more than 350 cells/ml.…”