910 Progression to AIDS/Death is Higher in Patients Initiating Antiretroviral Therapy with CD4 Counts below 350 Cells/µL E. Ferrer*, E. Santamarina, M. Santin, B. Roson, M. J. Barbera, E. Fumero, J. Niubo, D. Podzamczer Hosp de Bellvitge, Barcelona, Spain
Background: Time of initiation of Antiretroviral Therapy (ARV) therapy is a controversial issue, especially with regard to relationship between baseline CD4 counts and progression to AIDS or death. We evaluated risk factors associated with progression to AIDS (first or new disease) or death in a cohort of HIV-infected naive pts initiating ARV.
Methods: Since January 1997, HIV+ pts initiating ARV therapy were prospectively followed. At baseline, age, sex, risk practice, prior AIDS, CD4 count, viral load (VL) and ARV regimens were recorded in a database among many other variables, as well as CD4, VL, AIDS diseases and death during follow-up. Univariate (Kaplan-Meier) and multivariate (Cox model) analyses of risk factors associated with progression were performed.
Results: We followed 573 pts who initiated ARV therapy between 1997 and 2000, during a median of 36 (1-64) months, up to 05/2002. Fifty-four (54) pts (9.4%) progressed to AIDS/death. At baseline, median age was 38 (20-83) years, 76% were males, 49% drug users, 33% had AIDS, median CD4 count was 243 (1-1580) cells/µL, and median VL 60,430 (< 50 - >500,000) copies/ mL. 44% pts had CD4 < 200 and 39% VL > 100,000. Sixteen percent (16%) began therapy with mono/dual NUCs, 22% NNRTI-regimens, 60% PI-regimens, and 2% other. In univariate analysis, baseline CD4 < 350 (p < 0.001), prior AIDS (p < 0.001), and baseline VL > 100,000 (p = 0.003) were significantly associated with AIDS/death. In a multivariate Cox model, only baseline CD4 < 350 was independently associated with AIDS/death (RR 14.7, 95% CI, 3.6-60.5, p < 0.001). Probability of progression to AIDS/death was higher in pts initiating ARV with CD4 200-350 (11/127) vs. CD4 > 350 (2/189) (at 5 yrs, 11% vs 2%, p = 0.0004). Even if prior AIDS pts were excluded, differences remained statistically significant (at 5 yrs, 8% vs 2%, p = 0.016).
Conclusions: In this cohort, initiating ARV therapy with CD4 200-350 was associated with a higher risk of progression to AIDS/death compared to CD4 > 350. CD4 count was associated with progression to AIDS/death more strongly than VL.
