October 16, 2012
Starting HIV antiretroviral therapy may reduce the risk of serious non-AIDS-defining diseases in individuals recently diagnosed with HIV, according to a recent Spanish study published in the journal AIDS.
Although it is well known how modern HIV treatment has dramatically reduced AIDS-defining illnesses, it is less clear what impact antiretroviral therapy has on non-AIDS-defining illnesses (such as cardiovascular disease, cancers and psychiatric disorders), which have come to comprise an increasingly large proportion of the complications experienced by people living with HIV.
To explore this question, researchers from the Spanish AIDS Research Cohort (CoRIS) studied 5,185 treatment-naive patients, 86.5% of whom had been diagnosed in 2004 or later, and followed them until 2010. They found that the incidence rate of non-AIDS events (NAEs) was 28.93 per 1,000 person-years, while the incidence rate of AIDS-defining events was 25.23 per 1,000 person-years.
There were a total of 423 NAEs in 367 patients. The most common NAEs were psychiatric disorders, liver disease, cancers, kidney disease and cardiovascular disease. After adjusting for potential confounding factors, older age, a high viral load and a low CD4+ count were associated with the occurrence of NAEs, the investigators found.
However, starting treatment lowered the risk of NAEs, particularly psychiatric disorders and kidney disease. Aidsmap reported:
Depression requiring drug therapy accounted for 70% of all psychiatric events. Lung cancer (20%), non-Hogkin's lymphoma (14%), cancer of the head or neck (12%), liver cancer (9%) and anal cancer (9%) were the most common malignancies. The investigators note that most of these cancers were related to viral co-infections or lifestyle factors. They therefore recommend that "additional strategies should be adopted during the initial care to contribute to reducing mortality in recently diagnosed HIV-infected patients, including a more exhaustive intervention on HCV [hepatitis C virus], papillomavirus and smoking habits among others."
Incidence of non-AIDS-related illnesses fell from 35 cases per 1000 person-years in the period between 2004 and 2007 to 25 cases per 1000 person-years in the period 2007 to 2010 (p = 0.001).
This fall was accompanied by an increase in mean CD4 cell count at the time HIV therapy was started from 147 cells/mm3 to 278 cells/mm3 (p < 0.001).
A total of 173 participants (3%) died, and 29% of deaths were attributed to non-AIDS-related illnesses. The authors conclude: "NAEs are a frequent cause of morbidity and mortality during initial follow-up, with a predominance of psychiatric, hepatic and renal-related diseases. Our results suggest a beneficial effect of cART [combination antiretroviral therapy] in the occurrence of NAEs, especially in psychiatric and renal-related NAEs."
The median age of the participants was 36 years and 79% were men. About 68% of the cohort started treatment during the study period.
Warren Tong is the research editor for TheBody.com and TheBodyPRO.com.
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