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ICAAC 2006; San Francisco, Calif.; September 27-30, 2006

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The Body Covers: The 46th Interscience Conference on Antimicrobial Agents and Chemotherapy
Risk for AIDS-Defining Events Is Greater Among Antiretroviral-Naive Patients Who Don't Achieve CD4+ Cell Count Above 200 on Treatment

September 29, 2006

A note from TheBody.com: Since this article was written, the HIV pandemic has changed, as has our understanding of HIV/AIDS and its treatment. As a result, parts of this article may be outdated. Please keep this in mind, and be sure to visit other parts of our site for more recent information!

For a variety of reasons, many HIV-infected patients begin antiretroviral treatment when their CD4+ cell counts are extremely low. Although many patients with low CD4+ cell counts who have good adherence to their regimen can achieve an undetectable HIV viral load, their CD4+ cell counts may not increase significantly above a count of 200/mm3. It is known that patients with CD4+ cell counts below 200/mm3 who are not on antiretroviral treatment are at significant risk of developing AIDS-defining illnesses, such as opportunistic infections or certain cancers. It is less clear whether patients with advanced HIV disease who start antiretroviral treatment who are able to achieve viral suppression but whose CD4+ cell count remains below 200/mm3 are still at risk for developing opportunistic infections.

Mona Loutfy and colleagues attempt to answer this question by studying the British Columbia HIV-infected cohort.1 Patients with a baseline CD4+ cell count of less than 200 and a detectable HIV-1 viral load who were antiretroviral na?ve and started antiretroviral treatment between August 1996 and September 2003 were included in the study.

Patients also had to achieve an undetectable viral load within the first year of antiretroviral treatment. The primary endpoint was non-accidental death or an AIDS event and whether the CD4+ cell count was below or above 200 after one year of antiretroviral treatment. A univariate Cox proportional hazard regression model was used in the analysis.


Univariate Cox Regression: All Clinical Events
Image by Mona Loutfy, M.D.; reprinted with permission. Click here to download the complete poster.


Univariate Cox Regression: Clinical Events After Year 1
Image by Mona Loutfy, M.D.; reprinted with permission. Click here to download the complete poster.


Two hundred and ninety nine patients were identified that met the inclusion criteria, of which, 202 did and 97 did not achieve a CD4+ cell count more than 200/mm3 after one year of antiretroviral treatment. Overall, the mean age was 42 years, 86% male, 15% were injection drug users and 50% used an NNRTI in their first antiretroviral regimen.

There were no significant demographic differences between the two groups. The only significant baseline difference in the two groups was the CD4+ cell count. The median CD4+ cell count for the entire group was 80/mm3, but it was 40/mm3 in those who did not achieve a CD4+ cell count of more than 200/mm3 and it was 120/mm3 at baseline for those who did.

There were 27 endpoints overall, 21 AIDS defining illnesses and six deaths. 10/97 (10.3%) and 17/202 (8.4%) patients had clinical endpoints. 4/97 (4.1%) and 5/202 (2.5%) had clinical events after one year of follow-up. Significant variables associated with a decreased likelihood of an event were an adherence rate of more than 95%, higher baseline CD4+ cell count, and time-dependent CD4+ cell count. Failure to achieve a CD4+ cell count of more than 200/mm3 was associated with a hazard ratio (HR) of 3.08 for developing a clinical event and a HR of 3.94 after one year, both of which just bordered on statistical significance.

The study indicates that patients who do not achieve a CD4+ cell count of more than 200/mm3 are at somewhat greater risk of developing AIDS clinical events than those who do. The total number of events was small in each group but the trend did favor increased events in those whose CD4+ cell counts remained below 200/mm3. This group also had significantly less CD4+ cells prior to starting antiretroviral treatment and was thus at greater risk from the outset.

Interestingly, clinical events happened at a median of 2.2 months after starting antiretroviral treatment, most likely when their CD4 count was still significantly depressed. We were not told whether all or some of these patients were taking opportunistic infection prophylaxis medications, which could have affected whether they developed a clinical endpoint or not. It was apparent though that adherence to antiretroviral meds was very important in helping prevent clinical events.

Footnote

  1. Loutfy MR, Yip B, Moore D, et al. Increased Clinical Events in HIV-infected Patients who Achieve Full Virologic Suppression but Fail to Attain a Cd4 Count > 200 Cells/mm3 after One Year of Combination Antiretroviral Therapy (cART). In: Program and abstracts of the 46th Annual Interscience Conference on Antimicrobial Agents and Chemotherapy; September 27-30, 2006; San Francisco, Calif. Abstract H-1403.
    View poster: Download PowerPoint

A note from TheBody.com: Since this article was written, the HIV pandemic has changed, as has our understanding of HIV/AIDS and its treatment. As a result, parts of this article may be outdated. Please keep this in mind, and be sure to visit other parts of our site for more recent information!



  
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Please note: Knowledge about HIV changes rapidly. Note the date of this summary's publication, and before treating patients or employing any therapies described in these materials, verify all information independently. If you are a patient, please consult a doctor or other medical professional before acting on any of the information presented in this summary. For a complete listing of our most recent conference coverage, click here.

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