7th Conference - Abstract 241

Low Rates of All Opportunistic Infections among Patients with Advanced HIV Disease Responding to Antiretroviral Therapy - the CPCRA 048 Cohort

W. BURMAN*, W. EL-SADR, L. GRANT, J. MATTS, D. ZEH, B. GALLAGHER, R. HAFNER, L. CRANE, and F. GORDIN. The Terry Beirn Community Programs for Clin. Res. on AIDS

Background: There have been concerns that patients with advanced HIV disease would remain vulnerable to opportunistic infections (Ols) despite a CD4 cell response to highly-active antiretroviral therapy (HAART) because of permanent deletion of key CD4 cell clones. We evaluated the risk of Ols among patients responding to HAART who enrolled in a trial of MAC prophylaxis withdrawal.
Methods: Patients with a CD4 rebound from < 50 to > 100 who were randomized to azithromycin vs. placebo in CPCRA 048 were evaluated for the risk of common Ols.
Results: The mean nadir CD4 cell count of the 520 patients enrolled was 24/mm³, and 65% had a prior AIDS-defining illness. At enrollment, the mean CD4 cell count was 261/mm³, and the cohort was followed for an average of 12 months. Rates of Ols (per 100 patient years) in the CPCRA 048 cohort and those in trials of first-line prophylactic drugs in the pre-HAART era are listed below.

Conclusions: The CD4 cell response to HAART appears to provide
protection superior to that provided by first-line prophylactic agents. This
study provides additional evidence that potent and broad-based immune
reconstitution occurs among patients with advanced HIV disease.

Key Words: epidemiology, opportunistic infections, prophylaxis