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My name is Benoît Marin. I come from France. I'm working on the data from CASCADE collaboration. It's a collaboration of 23 seroconverters cohorts in Europe, Canada and Australia. The important point of this collaboration is that the cohorts are seroconverters cohorts, so we know an estimated date of seroconversion for these people.

The objective of these studies was to assess the adjusted relationships between the markers of immunodepression and the non-AIDS-related causes of death. That's the reason why we used the 11 causes of death, the AIDS scores and values, non-AIDS scores. We used the different markers of immunodepression, the nadir during the follow-up, the nadir before the initiation of a cART treatment, the latest CD4 counts, of course. We used cumulative time under 350 cells/µL.

The results of this study are: First of all, there is, of course, a gradient effect for nadir CD4 count and latest CD4 count on AIDS-related death, of course. There is a strong association between these markers of immunodepression and the non-AIDS-infection deaths. It's a very important point. There is also an association for liver disease death and non-AIDS-related cancer.

Is that related to hepatitis B or C coinfection?

For liver disease, yes. Whether it is B, C; yes. There were no associations between the markers of immunodepression and suicide. We can see that for cardiovascular disease, the results were the same. There were no associations in our results between immunodepression and cardiovascular disease.

Could you explain that, why you thought there was no association? Is there a guess?

I thought I would find an association, but we can't see anything. However, there were associations between the HIV RNA level during the follow-up, and these causes of death. Maybe there is different physiopathological hypothesis to put under stress, because there is an association with immunodepression for infections and non-AIDS cancer for these causes. We know that immunodepression is an important point. But for cardiovascular disease, it may not be immuno-depression but high replication, inflammation, cytokines; we don't know. Maybe this result is important that there is an association with HIV RNA. But we need other studies.

To conclude, I see that you say that these results plead for earlier initiation of antiretrovirals, to reduce the impact of the most frequent, specific causes of death. How early should people begin? What's the magic number?

[Laughs] Magic number -- nobody knows. Of course, not below 350 cells/mm³. I think 200 cells/mm³ is not a good number. I don't know [about starting] over 350 cells/mm³. Of course, not below 350 cells/mm³.

Thank you.

To view the study abstract from Dr. Marin's presentation, click here.

To view Dr. Marin's poster, click here.