Uncontrolled viral replication as a risk factor for non-AIDS severe clinical events in HIV-infected patients on long-term antiretroviral therapy: APROCO/COPILOTE (ANRS CO8) cohort study.
Leport C, Raffi F, Chêne G, Salamon R, Moatti JP, Pierret J, Spire B, Brun-Vézinet F, Fleury H, Masquelier B, Peytavin G, Garraffo R, Costagliola D, Dellamonica P, Katlama C, Meyer L, Salmon D, Sobel A, Cuzin L, Dupon M, Duval X, Le Moing V, Marchou B, May T, Morlat P, Rabaud C, Waldner-Combernoux A, Collin-Filleul F, Job-Spira N, Trumeau M, Perronne C, Le Moing V, Lewden C, Biemar J, Boucherit S, Bouhnik A, Brunet-François C, Carrieri M, Couturier F, Ecobichon J, Guiyedi V, Kurkdji P, Martiren S, Préau M, Protopopescu C, Roy C, Surzyn J, Taieb A, Villes V, Wallet C, Schmit J, Chennebault JM, Faller J, Dupond J, Estavoyer J, Drobachef, Bouchaud O, Dupon M, Longy-Boursier, Morlat P, Ragnaud JM, Granier P, Garré M, Verdon R, Merrien D, Devidas A, Sobel A, Portier H, Perronne C, Lagarde P, Ceccaldi J, Peyramond D, Allard C, Reynes J, May T, Raffi F, Fuzibet J, Dellamonica P, Arsac P, Bouvet E, Bricaire F, Bergmann P, Cabane J, Monsonego J, Girard PM, Guillevin L, Herson S, Leport C, Meyohas MC, Molina J, Pialoux G, Salmon D, Becq-Giraudon B, Jaussaud R, Michelet C, Lucht F, Debord T, Lang J, De Jaureguiberry JP, Marchou B, Besnier J.
Source
Service de Maladies Infectieuses et Tropicales, Hospices Civils de Lyon, Hôpital de la Croix-Rousse, Université Claude Bernard Lyon 1, Lyon, France.
Abstract
OBJECTIVE:
To determine risk factor for non-AIDS severe clinical events in HIV-infected patients on long-term combination antiretroviral therapy (cART).
METHODS:
A validation committee reviewed each severe clinical event that occurred in the APROCO/COPILOTE (ANRS CO8) cohort that enrolled 1281 patients in 1997-1999 at the initiation of cART containing protease inhibitor. Probability of the occurrence of a first non-AIDS, cART-related, and AIDS-defining event was estimated, and potential determinants were studied using Cox regression models.
RESULTS:
During a median follow-up of 7.3 years, the incidence of non-AIDS events was higher than that of cART-related and AIDS-defining events (10.5, 3.6, and 2.6 per 100 patient-years, respectively). Bacterial (mainly airway) infections were the most frequent non-AIDS events (23.4%) followed by non-AIDS-defining malignancies and cardiovascular events (both 9.5%). Factors independently associated with the occurrence of a first non-AIDS event were age >60 years [hazard ratio (HR) 2.1; 95% confidence interval (CI): 1.3 to 3.2] and CD4 <100 cells per milliliter (HR 2.5; 95% CI: 1.8 to 3.6) but also plasma HIV RNA >4 log10 copies per milliliter at the time of the event (HR 1.9; 95% CI: 1.5 to 2.5).
CONCLUSION:
Optimization and permanent continuation of long-term antiretroviral therapy in HIV-infected patients is the best strategy to prevent or reduce the occurrence of non-AIDS severe morbidity.
- PMID:
- 19474755
- [PubMed - indexed for MEDLINE]
-
Publication Types
MeSH Terms