20. Factors Associated with Clinical Progression in HIV-2-Infected Patients Included in the French ANRS Cohort

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Session 5 Oral Abstract Session
Epidemiology and Infection Control
Session Time: Monday, 10 am - 12:30 pm
Room 6C

12:15 20.

Factors Associated with Clinical Progression in HIV-2-Infected Patients Included in the French ANRS Cohort
S. Matheron*¹, S. Pueyo², F. Damond³, P. Campa¹, F. Simon⁴, G. Chęne², and F. Brun-Vezinet³ for the French HIV-2 Cohort Study Group
^1,3Bichat-Claude Bernard Hosp., Paris; ²INSERM U330, Bordeaux; and ⁴CHU Rouen, France

Background: Our purpose was to identify factors associated with clinical progression (new B or C event or death) in the French HIV-2 national cohort.
Methods: A prospective, multicenter cohort of adult HIV-2-infected patients was initiated in 1994. Epidemiological, clinical, biological, and therapeutic data were collected twice a year. Viral load was assessed once a year by cellular viremia, quantitative proviral DNA and plasma RNA (real-time PCR with detection limit of 5 copies/105 cells and 250 log₁₀ c/mL, respectively). A Cox proportional-hazards model was used for studying baseline factors associated with clinical progression: sex, age, transmission category, CDC stage, CD4 cell count, HBs Ag, HCV Ab, viral load, and antiretroviral therapy (ART).
Results: By June 2001, analyses were performed on 217/238 recruited patients. At inclusion, 80%, 6%, and 14% were classified CDC group A, B, and C, respectively. Median CD4+ count was 436/mm³. In the specimens detected positive (65/135; 48%), the median plasma RNA titer was 3.0 log₁₀copies/mL. The mean follow-up of the 179 patients seen at least twice was 34.4 months. Out of them 13 deceased, 9 progressed from group A or B to group C. 93 patients received ART during a mean 33-month-period, including a protease inhibitor in 48% of them. From AIDS diagnosis (n=40), survival was 92% at 1 year and 80% at 3 years. The probability of remaining AIDS-free was 97% at 1 year in groups A and B patients (n=152). Independent variables associated with the occurrence of clinical progression were age >40 years (RH: 11; 95% CI, 1.4-91.8, p=0.03) and quantitative plasma RNA (RH: 2.5; 95% CI, 1.3-4.7, p<0.01). The risk of progression was significantly higher in patients with RNA >1000 copies/mL (26% vs 6%; p<0.01). The risk was 40% when RNA >5000 copies/mL. AIDS and quantitative plasma RNA were predictive of death. Prior group B symptoms and CD4<200/mm³ were associated with progression to AIDS.
Conclusion: In pts with AIDS, or in the presence of B symptoms or with CD4<200/mm³, ART is recommended. In the other patients with positive plasma RNA, a close follow-up is recommended and initiation of ART should be considered when RNA is >1000-5000 copies/mL.

Š2002 9^th Conference on Retroviruses and Opportunistic Infections