Risk of severe non AIDS events is increased among patients unable to increase their CD4 + T-cell counts >200+/μl despite effective HAART

Giuseppe Lapadula, Liliane Chatenoud, Andrea Gori, Francesco Castelli, Simona Di Giambenedetto, Massimiliano Fabbiani, Franco Maggiolo, Emanuele Focà, Nicoletta Ladisa, Laura Sighinolfi, Massimo Di Pietro, Angelo Pan, Carlo Torti, G. Carosi, E. Quiros, P. Nasta, G. Paraninfo, R. Cauda, M. Colafigli, A. ScalziniF. Castelnuovo, I. El Hamad, F. Mazzotta, S. Locaputo, P. Pierotti, N. Marino, C. Blè, F. Vichi, G. Angarano, N. Ladisa, L. Monno, P. Maggi, S. Costarelli, M. Puoti, P. Viale, V. Colangeli, M. Borderi

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Immunological non-response (INR) despite virological suppression is associated with AIDS-defining events/death (ADE). Little is known about its association with serious non-AIDS-defining events (nADE). Methods Patients highly-active antiretroviral therapy (HAART) with 50. Results: 1221 patients were observed for a median of 3 (IQR: 1.3-6.1) years. Pre-HAART CD4+were 77/μl (IQR: 28-142) and 56% of patients had experienced an ADE. After 1 year, CD4+ increased to 286 (IQR: 197-387), but 26.1% of patients were INR. Thereafter, 86 nADE (30.2% malignancies, 27.9%infectious, 17.4%renal, 17.4%cardiovascular, 7% hepatic) were observed, accounting for an incidence of 1.83 events (95%CI: 1.73-2.61) per 100 PYFU. After adjusting for measurable confounders, INR had a significantly greater risk of nADE (HR 1.65; 95%CI: 1.06-2.56). Older age (per year, HR 1.03; 95%CI: 1.01-1.05), hepatitis C co-infection (HR 2.09; 95%CI: 1.19-3.7), a history of previous nADE (HR 2.16; 95% CI: 1.06-4.4) and the occurrence of ADE during the follow-up (HR 2.2; 95%CI: 1.15-4.21) were other independent predictors of newly diagnosed nADE. Conclusions: Patients failing to restore CD4+ to >200 cells/μl run a greater risk of serious nADE, which is intertwined or predicted by AIDS progression. Improved management of this fragile population and innovative therapy able to induce immune-reconstitution are urgently needed. Also, our results strengthen the importance of earlier diagnosis and HAART introduction.

Original languageEnglish
Article numbere0124741
JournalPLoS One
Volume10
Issue number5
DOIs
Publication statusPublished - May 28 2015

ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

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