Patients presenting with AIDS in the HAART era

A collaborative cohort analysis

Cristina Mussini, Christian Manzardo, Margaret Johnson, Antonella D Arminio Monforte, Caterina Uberti-Foppa, Andrea Antinori, M. John Gill, Laura Sighinolfi, Vanni Borghi, Adriano Lazzarin, José M. Miro, Caroline Sabin

Research output: Contribution to journalArticle

52 Citations (Scopus)

Abstract

Objective: Many patients infected with HIV still present with an AIDS diagnosis. The aim of this study was to evaluate the virological, immunological and clinical outcomes of HAART in these patients. Design: The present study was a multi-cohort study. All patients with an AIDS diagnosis between 30 days before and 14 days after HIV diagnosis, recruited between 1997 and 2004 from eight hospital cohorts, were evaluated. Results: A total of 760 patients were included [268 (35.3%) had Pneumocystis and 168 (22.1%) tuberculosis]. Six hundred and twenty-four patients (82.1%) started HAART a median of 31 days after HIV diagnosis. One hundred and fifty-three patients started a nonnucleoside transcriptase inhibitor-based regimen (20.1%), 409 a protease inhibitorbased regimen (53.8%) and 62 other regimens (8.2%). In adjusted analyses, HAART was started sooner in more recent years, in patients with lower CD4 cell count and in those with Kaposi's sarcoma, whereas it was started later in those with tuberculosis. Five hundred and five patients (89%) attained a viral load of less than 500 copies/ml. The factors associated with a better virological response were later calendar year, lower initial viral load and cytomegalovirus disease. Virological rebound was more common in those receiving nucleoside reverse transcriptase inhibitor-based regimens, in those with tuberculosis and in earlier calendar years. One hundred and twenty-five (16%) patients died; 61 had received HAART (48.6%). Mortality was more likely in those who were older, those with a higher viral load at diagnosis, those with nonsexual HIV risks and those with lower CD4 cell count and haemoglobin levels over follow-up. Conclusion: Virological suppression was achieved in most AIDS patients, though mortality remains high in these individuals.

Original languageEnglish
Pages (from-to)2461-2469
Number of pages9
JournalAIDS (London, England)
Volume22
Issue number18
DOIs
Publication statusPublished - 2008

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Highly Active Antiretroviral Therapy
Acquired Immunodeficiency Syndrome
Cohort Studies
Viral Load
HIV
Tuberculosis
CD4 Lymphocyte Count
Pneumocystis
Reverse Transcriptase Inhibitors
Mortality
Kaposi's Sarcoma
DNA-Directed RNA Polymerases
Cytomegalovirus
Nucleosides
Hemoglobins
Peptide Hydrolases

Keywords

  • AIDS
  • AIDS presenters
  • Opportunistic infections
  • Prognosis

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Infectious Diseases

Cite this

Patients presenting with AIDS in the HAART era : A collaborative cohort analysis. / Mussini, Cristina; Manzardo, Christian; Johnson, Margaret; Monforte, Antonella D Arminio; Uberti-Foppa, Caterina; Antinori, Andrea; Gill, M. John; Sighinolfi, Laura; Borghi, Vanni; Lazzarin, Adriano; Miro, José M.; Sabin, Caroline.

In: AIDS (London, England), Vol. 22, No. 18, 2008, p. 2461-2469.

Research output: Contribution to journalArticle

Mussini, C, Manzardo, C, Johnson, M, Monforte, ADA, Uberti-Foppa, C, Antinori, A, Gill, MJ, Sighinolfi, L, Borghi, V, Lazzarin, A, Miro, JM & Sabin, C 2008, 'Patients presenting with AIDS in the HAART era: A collaborative cohort analysis', AIDS (London, England), vol. 22, no. 18, pp. 2461-2469. https://doi.org/10.1097/QAD.0b013e328314b5f1
Mussini, Cristina ; Manzardo, Christian ; Johnson, Margaret ; Monforte, Antonella D Arminio ; Uberti-Foppa, Caterina ; Antinori, Andrea ; Gill, M. John ; Sighinolfi, Laura ; Borghi, Vanni ; Lazzarin, Adriano ; Miro, José M. ; Sabin, Caroline. / Patients presenting with AIDS in the HAART era : A collaborative cohort analysis. In: AIDS (London, England). 2008 ; Vol. 22, No. 18. pp. 2461-2469.
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abstract = "Objective: Many patients infected with HIV still present with an AIDS diagnosis. The aim of this study was to evaluate the virological, immunological and clinical outcomes of HAART in these patients. Design: The present study was a multi-cohort study. All patients with an AIDS diagnosis between 30 days before and 14 days after HIV diagnosis, recruited between 1997 and 2004 from eight hospital cohorts, were evaluated. Results: A total of 760 patients were included [268 (35.3{\%}) had Pneumocystis and 168 (22.1{\%}) tuberculosis]. Six hundred and twenty-four patients (82.1{\%}) started HAART a median of 31 days after HIV diagnosis. One hundred and fifty-three patients started a nonnucleoside transcriptase inhibitor-based regimen (20.1{\%}), 409 a protease inhibitorbased regimen (53.8{\%}) and 62 other regimens (8.2{\%}). In adjusted analyses, HAART was started sooner in more recent years, in patients with lower CD4 cell count and in those with Kaposi's sarcoma, whereas it was started later in those with tuberculosis. Five hundred and five patients (89{\%}) attained a viral load of less than 500 copies/ml. The factors associated with a better virological response were later calendar year, lower initial viral load and cytomegalovirus disease. Virological rebound was more common in those receiving nucleoside reverse transcriptase inhibitor-based regimens, in those with tuberculosis and in earlier calendar years. One hundred and twenty-five (16{\%}) patients died; 61 had received HAART (48.6{\%}). Mortality was more likely in those who were older, those with a higher viral load at diagnosis, those with nonsexual HIV risks and those with lower CD4 cell count and haemoglobin levels over follow-up. Conclusion: Virological suppression was achieved in most AIDS patients, though mortality remains high in these individuals.",
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