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Increased Risk of Clinical Event if CD4 <200 After Starting HAART
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Researchers from Vancouver reported there is an increased risk for "Clinical Events in HIV-infected Patients who achieve full virologic suppression but fail to attain a CD4 Count >200 cells in the first year after starting HAART and if CD4 does not increase >200 after one year on HAART there remained an increased risk"
Authors: M. R. LOUTFY1, B. YIP 2, D. MOORE 2, J. RABOUD 1, S. SHEN 1, J. S. G. MONTANER 2, R. HOGG 2;
1Univ. of Toronto, Toronto, Canada, 2British Columbia Ctr. for Excellence in HIV/AIDS, Vancouver, Canada.
Some patients starting HAART achieve full viral suppression (<50 copies/mL) but fail to have a CD4 increase >200. The purpose of this study was to determine if such patients are at greater risk of clinical events.
A cohort of ART-naïve patients from British Columbia, Vancouver, Canada HIV-infected cohort of ART-naïve pts >18 years of age who initiated HAART between 08/1996 and 09/2003 was used for this analysis.
The analyzed patients had a baseline CD4<200 and >50 copies/mL and had achieved 2 sequential viral loads <50c/mL within the first year of HAART.
The primary endpoint of this study was non-accidental death or an AIDS event.
Subjects were followed until death, AIDS, viral load >50c/mL or 09/2004. The predictor of interest was whether the one-year CD4 count was < or >200. Univariate Cox regression was used to model the occurrence of a clinical event.
Results published in program book
299 pts with a median follow-up of 21 months were analyzed.
97 (32%) of patients did not achieve a CD4 >200 after one year of HAART (while 202 (67%) did) despite having achieved <50 copies/ml of viral load.
10/97 (10%) pts with CD4<200 and 17/202 (8.4%) pts with CD4 >200 experienced a clinical event (p=0.59).
The clinical events occurred at a median of 2.2 months after HAART. There were 9 events after one year of HAART; 4 (4.1%) in the <200 group and 5 (2.5%) in the >200c/mm3 group (p=0.48).
In Cox models for events after HAART, significant covariates were: adherence >95% (HR=0.34), baseline CD4 (HR=0.45 /100 cells), time-dependent CD4 (HR=0.48 /100 cells) and failure to attain a CD4 >200c/mm3 (HR=3.08; p=0.055). In the Cox model for events after one year, failure to attain a CD4 >200c/mm3 had some significance (HR=3.94; p=0.08).
The authors concluded: HIV-infected pts on HAART who achieve complete viral suppression but fail to attain CD4 >200 have increased rates of clinical events in the first year of HAART. If the CD4 count did not rise >200 after one year, there remained an increased risk of clinical events thereafter.
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