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AIDS. 2012 Feb 20;26(4):465-74. doi: 10.1097/QAD.0b013e32834f32f8.

Long-term complications in patients with poor immunological recovery despite virological successful HAART in Dutch ATHENA cohort.

Collaborators (116)

Prins JM, Kuijpers TW, Scherpbier HJ, Boer K, van der Meer JT, Wit FW, Godfried MH, Reiss P, van der Poll T, Nellen FJ, Lange JM, Geerlings SE, van Vugt M, Pajkrt D, Bos JC, van der Valk M, Grijsen ML, Wiersinga WJ, Schreij G, Lowe S, Lashof AO, Pronk MJ, Bravenboer B, van der Ende ME, de Vries-Sluijs TE, Schurink CA, van der Feltz M, Nouwen JL, Gelinck LB, Verbon A, Rijnders BJ, Slobbe L, van Gorp EC, Hartwig NG, Driessen GJ, Branger J, Schippers EF, van Nieuwkoop C, Groeneveld PH, Alleman MA, Bouwhuis JW, ten Kate RW, Soetekouw R, Kroon FP, van den Broek PJ, van Dissel JT, Arend SM, van Nieuwkoop C, de Boer MG, Jolink H, den Hollander JG, Pogany K, van Twillert G, Kortmann W, Vriesendorp R, Leyten EM, Geelink LB, ten Napel CH, Kootstra GJ, Brinkman K, Blok WL, Frissen PH, Schouten WE, van den Berk GE, Juttmann JR, van Kasteren ME, Brouwer AE, Veenstra J, Lettinga KD, Mulder JW, Smit PM, Vrouenraets SM, Lauw FN, van Eeden A, Verhagen DW, Sprenger HG, Doedens R, Scholvinck EH, van Assen S, Bierman WF, Koopmans PP, de Groot R, Keuter M, van der Ven AJ, ter Hofstede HJ, van der Flier M, Brouwer AM, Dofferhoff AS, Hoepelman AI, Mudrikova T, Schneider MM, Jaspers CA, Ellerbroek PM, Oosterheert JJ, Arends JE, Wassenberg MW, Barth RE, van Agtmael MA, de Vocht J, Perenboom RM, Claessen FA, bij de Vaate EA, Geelen SP, Wolfs TF, Bont LJ, Richter C, van der Berg JP, Gisolf EH, van den Berge M, Stegeman A, van Vonderen MG, van Houte DP, Winkel C, Muskiet F, Durand, Voigt R.

Author information

  • 1Department of Internal Medicine & Infectious Diseases, University Medical Center Utrecht, The Netherlands. s.f.l.vanlelyveld@umcutrecht.nl

Abstract

OBJECTIVE:

We investigated the risk of AIDS and serious non-AIDS-defining diseases (non-ADDs) according to the degree of immunological recovery after 2 years of virological successful antiretroviral therapy (HAART).

DESIGN:

Retrospective observational cohort study including HIV-infected patients treated with HAART resulting in viral suppression (<500 copies/ml).

METHODS:

Patients were grouped according to their CD4 cell count after 2 years of HAART: CD4 cell count less than 200 cells/μl (group A), 200-350 cells/μl (group B), 351-500 cells/μl (group C) or more than 500 cells/μl (group D). Analysis was done to assess predictors for poor immunological recovery and the occurrence of a composite endpoint [death, AIDS, malignancies, liver cirrhosis and cardiovascular events (CVEs)], non-ADDs, CVEs and non-AIDS-defining malignancies (non-ADMs).

RESULTS:

Three thousand and sixty-eight patients were included. Older age, lower CD4 cell nadir and lower plasma HIV-RNA at the start of HAART were independent predictors for a poor immunological recovery. The composite endpoint, non-ADDs and CVE were observed most frequently in group A (overall log rank, P < 0.0001, P = 0.002 and P = 0.01). In adjusted analyses, age was a strong independent predictor for all endpoints. Compared with group A, patients in group D had a lower risk for the composite endpoint [hazard ratio 0.54 (95% confidence interval [CI] 0.33-0.87]; patients in group B had a lower risk for CVEs [hazard ratio 0.34 (95% CI 0.14-0.86)].

CONCLUSION:

Poor immunological recovery despite virological successful HAART is associated with a higher risk for overall morbidity and mortality and CVEs in particular. This study underlines the importance of starting HAART at higher CD4 cell counts, particularly in older patients.

PMID:
22112603
[PubMed - indexed for MEDLINE]
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