Predictors of AIDS-defining events among advanced naïve patients after HAART

Carlo Torti, Giuseppe Lapadula, Franco Maggiolo, Salvatore Casari, Fredy Suter, Lorenzo Minoli, Chiara Pezzoli, Massimo Di Pietro, Guglielmo Migliorino, Eugenia Quiros-Roldan, Nicoletta Ladisa, Laura Sighinolfi, Francesca Gatti, Giampiero Carosi

Research output: Contribution to journalArticle

Abstract

Background: Baseline and follow-up predictors of new AIDS-defining events or death (ADE/death) among patients who started HAART late in their disease history have rarely been assessed simultaneously. Method: ADE and mortality rates were assessed using Cox regression analyses. Variables were tested for prediction of ADE/death within the first 3 months of therapy and from month 3, thereafter. Results: 751 HIV-infected patients with 3 before HAART were followed for a median of 49 months. 207 new ADE occurred (7.06 [6.16-8.10] per 100 patient-years). ADE/deaths clustered within the first 3 months of treatment (106/207, 51%). Higher CD4+ T-cell counts during the follow-up (per loge cells/mm3: hazard ratio [HR] 0.51; 0.41-0.64; p <.001) and use of antiretroviral therapy (HR 0.38; 95% CI 0.21-0.69; p = .001) appeared to protect from ADE/death after month 3. Conversely, increasing follow-up with HIV RNA >400 copies/mL correlated with ADE/death (per month: HR 1.09; 95% CI 1.06-1.12; p = .001). Use of boosted protease inhibitors as first-line HAART and HCV-seropositivity were additional risk factors. Baseline CD4+ T-cell count and HIV RNA had a predominant impact in the first 3 months after HAART initiation. Conclusion: A careful monitoring of patients with low CD4+ is particularly necessary during the first few months of HAART. Length and extent of viral replication during the follow-up appeared to induce a significantly higher risk of HIV disease progression afterwards, implying that new drugs and new strategies aimed at ensuring long-term suppression of HIV RNA are of outstanding importance.

Original languageEnglish
Pages (from-to)112-120
Number of pages9
JournalHIV Clinical Trials
Volume8
Issue number3
DOIs
Publication statusPublished - May 2007

Keywords

  • Advanced naïve
  • AIDS
  • Death
  • HAART
  • Late presenter
  • Predictors

ASJC Scopus subject areas

  • Virology
  • Immunology

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    Torti, C., Lapadula, G., Maggiolo, F., Casari, S., Suter, F., Minoli, L., Pezzoli, C., Di Pietro, M., Migliorino, G., Quiros-Roldan, E., Ladisa, N., Sighinolfi, L., Gatti, F., & Carosi, G. (2007). Predictors of AIDS-defining events among advanced naïve patients after HAART. HIV Clinical Trials, 8(3), 112-120. https://doi.org/10.1310/hct0803-112