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Epidemiological features, therapeutic strategies and long-term immunological outcomes in virologically suppressed HIV+ very late presenters
© Martinelli et al; licensee BioMed Central Ltd. 2010
Published: 8 November 2010
Purpose of the study
In the Western world, approximately 30% of HIV-infected individuals are still very late presenters. The aim of this retrospective study is to describe epidemiological and clinical characteristics, as well as long-term immunological outcome in virologically suppressed HIV+ very late presenters.
We reviewed the medical records of all consecutive HIV+ patients with CD4 cell count < 200/ mmc3 at presentation, who had attended our clinic between 1996-2006, and had achieved a persistent virological suppression for at least 1 year. Demographic, clinical, virological and immunological data at baseline and at follow up visits were collected. The changes in CD4+ cell count during follow up was also examined, stratifying the population according to baseline age, HIV risk factors, CD4+ cell counts, HIV viral load , HCV co-infection.
Summary of results
Overall 164 very late presenters with a persistent virological response were examined. Caucasian and heterosexual males represent the largest part of this cohort of virological responder, very late presenter patients. IDUs and HCV coinfected patients were under-represented as compared to our HIV population, probably due to a lower adherence. Epidemiological and clinical characteristics of the study population: 61.2% had CD4+ cell count <50/µl. 123 patients started a protease inhibitor-based regimen (75%). Respectively 25% and 52% of initial NNRTI and PI-based regimen were modified during follow up (toxicity was the most common cause of switch). After 5 years of therapy a good immunological recovery (> 500 CD4 cell/µl) was observed in 30.7% and 46% of patients with baseline CD4+ cell count < 50/µl and 51-200/µl respectively.
CD4+ cell count increased even after 5 years, reaching a full immunological recovery (>700/µl) only in 17% of patients. Patients aged ≥ 50 years, IDUs and HCV co-infected had a slower and/or lower immune recovery; no significant differences in immunological response according to baseline viral load were observed.
A fair immune recovery over 5 years of HAART was seen. The CD4+ cell count restoration was conditioned by baseline values, age, HCV coinfection, and a complete immunological recovery was achieved in a very limited subset of patients.
This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.