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. 2009 Oct 23;23(16):2199-208.
doi: 10.1097/QAD.0b013e3283305a00.

Prognosis of patients treated with cART from 36 months after initiation, according to current and previous CD4 cell count and plasma HIV-1 RNA measurements

antiretroviral therapy cohort collaboration (ART-CC); Emilie Lanoy, Margaret May, Amanda Mocroft, Andrew Phillip, Amy Justice, Geneviève Chêne, Hansjakob Furrer, Timothy Sterling, Antonella D'Arminio Monforte, Lluís Force, John Gill, Ross Harris, Robert S Hogg, Jürgen Rockstroh, Mike Saag, Pavel Khaykin, Frank de Wolf, Jonathan A C Sterne, Dominique Costagliola

Prognosis of patients treated with cART from 36 months after initiation, according to current and previous CD4 cell count and plasma HIV-1 RNA measurements

antiretroviral therapy cohort collaboration (ART-CC) et al. AIDS. .

Abstract

Objectives: CD4 cell count and plasma viral load are well known predictors of AIDS and mortality in HIV-1-infected patients treated with combination antiretroviral therapy (cART). This study investigated, in patients treated for at least 3 years, the respective prognostic importance of values measured at cART initiation, and 6 and 36 months later, for AIDS and death.

Methods: Patients from 15 HIV cohorts included in the ART Cohort Collaboration, aged at least 16 years, antiretroviral-naive when they started cART and followed for at least 36 months after start of cART were eligible.

Results: Among 14 208 patients, the median CD4 cell counts at 0, 6 and 36 months were 210, 320 and 450 cells/microl, respectively, and 78% of patients achieved viral load less than 500 copies/ml at 6 months. In models adjusted for characteristics at cART initiation and for values at all time points, values at 36 months were the strongest predictors of subsequent rates of AIDS and death. Although CD4 cell count and viral load at cART initiation were no longer prognostic of AIDS or of death after 36 months, viral load at 6 months and change in CD4 cell count from 6 to 36 months were prognostic for rates of AIDS from 36 months.

Conclusions: Although current values of CD4 cell count and HIV-1 RNA are the most important prognostic factors for subsequent AIDS and death rates in HIV-1-infected patients treated with cART, changes in CD4 cell count from 6 to 36 months and the value of 6-month HIV-1 RNA are also prognostic for AIDS.

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Conflict of interest statement

All other authors declare that they have no conflicts of interest.

Figures

Fig. 1
Fig. 1. Kaplan–Meier estimate of cumulative probability of death after 36 months from start of cART by CD4 group (upper panel) and by HIV-1 RNA (lower panel)
cART, combination antiretroviral therapy.
Fig. 2
Fig. 2. Kaplan–Meier estimate of cumulative probability of AIDS after 36 months from start of cART by CD4 group (upper panel) and by HIV-1 RNA (lower panel)
cART, combination antiretroviral therapy.
Fig. 3
Fig. 3. Distribution of CD4 cell count (cells/µl)
(a) Distribution of CD4 cell count (cells/µl) at 36 months after cART initiation according to CD4 cell count at cART initiation. (b) Distribution of CD4 cell count (cells/µl) at 36 months after cART initiation according to CD4 cell count at 6 months. cART, combination antiretroviral therapy.
See this image and copyright information in PMC

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