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Predictors of Clinical Progression among HIV-1–Positive Patients starting HAART with CD4 + T-cell Counts ≥200 cells/mm 3

2007; SAGE Publishing; Volume: 12; Issue: 6 Linguagem: Inglês

10.1177/135965350701200611

2040-2058

Giuseppe Lapadula, Carlo Torti, Paolo Maggi, Salvatore Casari, Fredy Suter, L. Minoli, Chiara Pezzoli, Massimo Di Pietro, Guglielmo Marco Migliorino, Eugenia Quirós-Roldán, Nicoletta Ladisa, Laura Sighinolfi, Silvia Costarelli, Giampiero Carosi, Giampiero Carosi, Massimo Puoti, Carlo Torti, Eugenia Quirós-Roldán, Giuseppe Paraninfo, Salvatore Casari, Andrea Antinori, G. Antonucci, Adriana Ammassari, Angela Angarano, Annalisa Saracino, Roberto Cauda, Andrea De Luca, Antonella d’Arminio Monforte, Paola Cicconi, Francesco Mazzotta, Sergio Lo Caputo, N Marino, L. Minoli, Renato Maserati, Stefano Novati, Carmine Tinelli, F Ghinelli, L Sighinolfi, Giuseppe Pastore, Nicoletta Ladisa, Tiziana Quirino, Marco Migliorino, Fredy Suter, Paolo Maggi, Barbara Suligoi, Cristina Zeni, Francesca Brognoli, Ruth Bando,

HIV/AIDS Research and Interventions

Background Baseline and follow-up predictors of new AIDS-defining events (ADE) or death among patients who started HAART with CD4 + T-cell counts ≥200 cells/mm 3 have rarely been assessed simultaneously. Methods A prospective observational cohort study (1996–2002) is reported. HIV-infected patients initiating HAART with a CD4 + T-cell count ≥200 cells/mm 3 were studied. Baseline and time-varying factors were tested for the prediction of new ADE/death using Cox regression models. Results A total of 896 subjects were studied over a median of 5.1 years. The incidence of a new ADE was 1.6 (95% confidence interval 1.3–2.1) per 100 person-years. Among baseline factors, higher CD4 + T-cell counts before HAART were associated with lower risk of ADE/death, but not after adjustment for time-varying factors. On a multivariable analysis including both baseline and time-varying covariates, longer delay from HIV diagnosis to HAART was an independent predictor of ADE/death (per year, hazard ratio [HR] 1.06; P=0.025) and was independent of CD4 + T-cell count before treatment. Longer time spent with HIV RNA <400 copies/ml (per month, HR 0.96; P=0.003) and higher latest CD4 + T-cell count (per log 2 cells/mm 3 , HR 0.65; P<0.001) were found to be protective. Conclusions Patients with higher CD4 + T-cell counts before HAART initiation had a better prognosis. However, except for the delay in starting HAART, viro-immunological evolution outweighed the effect of baseline factors. Moreover, suppressing HIV replication for as long as possible could improve the clinical outcome. Prospective randomized clinical trials to assess the optimal timing of HAART initiation are both feasible and urgently needed.