Fatal and nonfatal AIDS and non-AIDS events in HIV-1-positive individuals with high CD4 cell counts according to viral load strata

Abstract

In individuals with a CD4 cell count more than 350 cells/μl, an increased incidence of AIDS and a slightly increased incidence of non-AIDS was found in those with uncontrolled viral replication. The association with AIDS was clear and consistent. However, the association with non-AIDS was only apparent after adjustment and no differences were observed between intermediate and high viraemia.

Incidence of AIDS-Defining Opportunistic Infections in a Multicohort Analysis of HIV-infected Persons in the United States and Canada, 2000–2010

“…Although direct comparisons of our observed OI rates to those reported from other cohorts are not appropriate because of multiple cross-cohort differences, including degree of immunosuppression and differences in analytic methods, our absolute OI incidence rates were generally of the same magnitude as in other studies of OIs during the ART era [3][4][5]. Higher HIV loads and lower CD4 + T-cell counts remained associated with OIs among patients, corroborating earlier analyses [1,21,24,34]. Since most persons in our analyses were ART recipients, these findings could reflect patients with more-recent ART initiation, suboptimal responses to ART, or medication nonadherence.…”

Rate and Predictors of Non-AIDS Events in a Cohort of HIV-Infected Patients with a CD4 T Cell Count Above 500 Cells/mm3

“…The CIR of non-AIDS and AIDS events of these patients was similar to that previously reported. 2 As expected, factors independently associated with the occurrence of a first non-AIDS/death event were age at baseline, a nadir CD4 below 350 cells/mm 3 , and a last determination of viral load above the median. It could be argued that the time on cART, the known duration of HIV infection, or the change in the management of HIV infection with time and not the nadir CD4 could explain the difference.…”

“…27 In addition, the prognostic effect of viral load and CD4 T cell count on clinical progression to AIDS has been consistently reported, 28 even in patients with a high CD4 T cell count. 2 Regarding the CD4 T cell level at cART initiation and risk of non-AIDS events, Baker et al 21 studied 1,397 patients who initiated ART and found that non-AIDS diseases were lowered by 14% for each 100 cells/mm 3 higher latest CD4 T cell count. Therefore, starting cART with a high CD4 T cell count could prevent the appearance of new non-AIDS events.…”

“…Some studies have shown an increased incidence of death 14 and non-AIDS events 2 in individuals with a CD4 T cell count above 350 cells/mm 3 with uncontrolled viral replication. It is also known that patients who started cART with a high CD4 T cell count had a lower risk of death than patients who delay the initiation of medication.…”

“…t has been extensively indicated that HIV-infected patients have an increase in so-called non-AIDS events, [1][2][3][4] especially cardiovascular 5 and neurocognitive events 6,7 and neoplasms [8][9][10][11][12] not traditionally associated with HIV infection. These could cause patients to have a shorter life expectancy as compared to people not infected by HIV.…”