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Risk of new AIDS defining events in patients with advanced immunodeficiency during suppressive HAART
Alexander Zoufaly1, Christina Kreuzberg1, Matthias an der Heiden2, Christian Kollan2, Osamah Hamouda2, Jan van Lunzen3
Background: A large number of HIV patients still present late with advanced immunodeficiency. In these patients the risk of developing AIDS-defining events (ADE) may depend on a solid immune reconstitution with immune-discordant responses being at higher risk.
Methods: Data of 1576 treatment naive patients starting HAART after 1.1.1996 at a CD4 count < 200 cells/µl were followed from the date of full viral suppression until virological failure, the occurrence of a new ADE, loss of follow-up or 31.12.2007. An adjusted Poisson regression model was used to analyze the relative rate (RR) between immune-discordance (all CD4 counts < 200 cells/µl) and immune-response (at least one CD4 count >200 cells/µl) in the first, second, and third year. In addition, a Cox model was fitted to analyze risk factors for a new ADE encompassing all available follow-up data.
Results: In the first year a total of 42 new ADE occurred with a IRR for immune-discordance of 5.57 (95%CI 2.96-10.48, p< 0.001) in the adjusted Poisson model. In the second (9 events) and third year (8 events) of viral control a non-significant trend towards a lower influence of immune-discordance was observed (IRR 1.03, 95%CI 0.13-8.26, p=0.98 and 2.02, 95%CI 0.25-16.41, p=0.51, respectively). In the Cox model analyzing 3633 person years of follow up risk factors significantly associated with development of a new ADE included the latest CD4 count below 50 cells/µl (HR 6.36,95%CI 2.53-15.95, p< 0.001) and CD4 counts between 50-100 cells/µl (HR 3.84,95%CI 1.70-8.68, p=0.001).
Conclusions: Immune-discordance is a risk factor for a new ADE while on HAART during the first year of suppressed viremia. After this time the incidence of ADE decreases dramatically even in patients with prolonged immunodeficiency. The risk is highest in patients who fail to increase CD4 counts to >100 cells/µl.
Datei SOEDAK_09_OSA3.pdf