- Oral presentation
- Open Access
O423 Risk of new AIDS-defining events in patients with advanced immunodeficiency during suppressive HAART: results from the German ClinSurv cohort
© Zoufaly et al; licensee BioMed Central Ltd. 2008
- Published: 10 November 2008
- Viral Suppression
- Immune Reconstitution
- Virological Failure
- Incidence Rate Ratio
- Poisson Regression Model
Despite recent advances in the reduction of morbidity and mortality after the advent of HAART, 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. We aimed to determine risk factors for the development of ADE in patients who begin fully suppressive antiretroviral treatment with CD4 counts <200 cells/μl.
Data of 1,576 treatment-naive patients starting HAART after January 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 December 31, 2007, whichever occurred first. An adjusted Poisson regression model was used to analyze the incidence rate ratio (IRR) 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.
In the first year a total of 42 new ADE occurred with an IRR for immune-discordance of 5.57 (95% CI 2.96–10.48, p < 0.001) in the adjusted Poisson model. In the second (nine events) and third year (eight 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 3,633 person-years of follow-up, risk factors for 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). No significant influence of latest CD4 count above 100 cells/μl, CD4 count at initiation of HAART, sex, age, transmission risk, and AIDS-defining event prior to initiation of HAART was observed.
This article is published under license to BioMed Central Ltd.