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Episodes of HIV Viremia and the Risk of Non-AIDS Events among Successfully Treated Patients (503)
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Reported by Jules Levin
CROI 2010 Feb 16-19 SF
Shuangjie Zhang*1, A van Sighem1, L Gras1, C Smit1, J Prins2, R Kauffmann3, C Richter4, P Reiss2, F de Wolf1,4, and the Natl Observational Athena Cohort
1HIV Monitoring Fndn, Amsterdam, The Netherlands; 2Academic Med Ctr, Univ of Amsterdam, The Netherlands; 3Haga Teaching Hosp, The Hague, The Netherlands; and 4Rijnstate Hosp, Arnhem, The Netherlands
ABSTRACT
Background: The association between immunodeficiency and the risk of non-AIDS diseases in HIV-infected patients has been previously reported. We investigated the additional impact of episodes of viremia and treatment interruptions on non-AIDS events in patients successfully treated with combination antiretroviral therapy (cART).
Methods: From the ATHENA cohort, 6440 previously ART-naive patients were selected who had RNA <50 cp/ml within 48 weeks after starting cART. Three non-AIDS endpoints were considered: 1) major cardiovascular disease (CVD; myocardial infarction, stroke, invasive coronary procedures), 2) renal disease (acute and chronic renal failure, kidney transplantation), 3) liver disease (cirrhosis, fibrosis). During follow-up, treatment interruptions and episodes of viral suppression (RNA <50 copies/mL), low-level viremia (50 to 400 copies/mL), and high-level viremia (>400 copies/mL) were considered. Patients were censored after one year of interruption. Poisson regression models, adjusted for demographic and clinical variables, were used to study the association between CD4 cell counts and the 4 types of episodes, included as time-updated variables, and the risk of non-AIDS events.
Results: During 25,986 person-years of follow-up, of which 89% spent in episodes of viral suppression, 102 patients developed CVD, 72 renal disease, and 70 liver disease. The overall incidence of non-AIDS events was 2.19 (95% confidence interval [CI], 1.59 to 2.94) per 100 person-years for CD4 counts <200 cells/mm3, 1.06 (0.79 to 1.39) for CD4 200 to 350 cells/mm3, 1.01 (0.77 to 1.29) for CD4 350 to 500 cells/mm3, and 0.64 (0.49 to 0.81) for CD4 >500 cells/mm3. Compared to CD4 >500 cells/mm3, CD4<200 cells/mm3 was associated with a higher risk of liver disease (relative risk [RR] 2.33, 95% CI 1.04 to 5.25) and renal disease (RR = 11.4, 5.16 to 25.2). No association was found between CD4 counts and CVD. Compared to viral suppression, interruptions and low-level viremia did not alter the risk of non-AIDS events, but high-level viremia was associated with a higher risk of CVD (RR 2.69, 1.29 to 5.63).
Conclusions: Lower CD4 counts were associated with an increased risk of renal and liver disease, but not CVD, while there appeared to be an independent association between high-level viremia and CVD. However, the power to detect an association of viremia may have been small given the limited amount of follow-up time spent in episodes of viremia.
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