Risk of severe non AIDS events is increased among patients unable to increase their CD4 + T-cell counts >200+/μl despite effective HAART
Articolo
Data di Pubblicazione:
2015
Citazione:
Risk of severe non AIDS events is increased among patients unable to increase their CD4 + T-cell counts >200+/μl despite effective HAART / G. Lapadula, L. Chatenoud, A. Gori, F. Castelli, S. Di Giambenedetto, M. Fabbiani, F. Maggiolo, E. Focà, N. Ladisa, L. Sighinolfi, M. Di Pietro, A. Pan, C. Torti, G. Carosi, E. Quiros, P. Nasta, G. Paraninfo, R. Cauda, M. Colafigli, A. Scalzini, F. Castelnuovo, I. El Hamad, F. Mazzotta, S. Locaputo, P. Pierotti, N. Marino, C. Blè, F. Vichi, G. Angarano, N. Ladisa, L. Monno, P. Maggi, S. Costarelli, M. Puoti, P. Viale, V. Colangeli, M. Borderi. - In: PLOS ONE. - ISSN 1932-6203. - 10:5(2015), pp. e0124741.1-e0124741.15. [10.1371/journal.pone.0124741]
Abstract:
Background: Immunological non-response (INR) despite virological suppression is associated with AIDS-defining events/death (ADE). Little is known about its association with serious non-AIDS-defining events (nADE). Methods Patients highly-active antiretroviral therapy (HAART) with <200 CD4+/μl and achieving HIVRNA <50 copies/ml within 12 (±3) months were categorized as INR if CD4+ T-cell count at year 1 was <200/μl. Predictors of nADE (malignancies, severe infections, renal failure-ie, estimated glomerular filtration rate <30 ml/min, cardiovascular events and liver decompensation) were assessed using multivariable Cox models. Follow-up was right-censored in case of HAART discontinuation or confirmed HIV-RNA>50. Results: 1221 patients were observed for a median of 3 (IQR: 1.3-6.1) years. Pre-HAART CD4+were 77/μl (IQR: 28-142) and 56% of patients had experienced an ADE. After 1 year, CD4+ increased to 286 (IQR: 197-387), but 26.1% of patients were INR. Thereafter, 86 nADE (30.2% malignancies, 27.9%infectious, 17.4%renal, 17.4%cardiovascular, 7% hepatic) were observed, accounting for an incidence of 1.83 events (95%CI: 1.73-2.61) per 100 PYFU. After adjusting for measurable confounders, INR had a significantly greater risk of nADE (HR 1.65; 95%CI: 1.06-2.56). Older age (per year, HR 1.03; 95%CI: 1.01-1.05), hepatitis C co-infection (HR 2.09; 95%CI: 1.19-3.7), a history of previous nADE (HR 2.16; 95% CI: 1.06-4.4) and the occurrence of ADE during the follow-up (HR 2.2; 95%CI: 1.15-4.21) were other independent predictors of newly diagnosed nADE. Conclusions: Patients failing to restore CD4+ to >200 cells/μl run a greater risk of serious nADE, which is intertwined or predicted by AIDS progression. Improved management of this fragile population and innovative therapy able to induce immune-reconstitution are urgently needed. Also, our results strengthen the importance of earlier diagnosis and HAART introduction
Tipologia IRIS:
01 - Articolo su periodico
Keywords:
Agricultural and Biological Sciences (all); Biochemistry; Genetics and Molecular Biology (all); Medicine (all)
Elenco autori:
G. Lapadula, L. Chatenoud, A. Gori, F. Castelli, S. Di Giambenedetto, M. Fabbiani, F. Maggiolo, E. Focà, N. Ladisa, L. Sighinolfi, M. Di Pietro, A. Pan, C. Torti, G. Carosi, E. Quiros, P. Nasta, G. Paraninfo, R. Cauda, M. Colafigli, A. Scalzini, F. Castelnuovo, I. El Hamad, F. Mazzotta, S. Locaputo, P. Pierotti, N. Marino, C. Blè, F. Vichi, G. Angarano, N. Ladisa, L. Monno, P. Maggi, S. Costarelli, M. Puoti, P. Viale, V. Colangeli, M. Borderi
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