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Session 101 Poster Abstracts
Antiretroviral Therapy: Regimens, Predictors of Response, and Clinical Outcomes
Thursday, 1:30 - 3:30 pm
Hall A


592    
Effect of HAART, CD4 Cell Counts, and Viral Load on Incidence of AIDS-defining Events
Isabelle Kousignian*1, S Abgrall2,3, S Grabar2,4, A Mahamat5, E Rouveix6, E Teicher7, D Costagliola1, and Clinical Epidemiology Group of the French Hospital Database on HIV
1INSERM EMI 0214, Paris, France; 2INSERM EMI 0214, Paris, France; 3Hosp Avicenne, Bobigny, France; 4Hosp Cochin, Paris, France; 5Ctr Hosp Univ de Nīmes, France; 6Ctr Hosp Univ Ambroise Paré, Boulogne, France; and 7Hosp Paul Brousse, Villejuif, France

Background:  HAART significantly reduces the incidence of AIDS-defining events, mainly by way of improved immune status when effective viral suppression has been obtained. In patients with virologic failure and deep immunosuppression, effect of maintenance of HAART on AIDS-defining events incidence as compared with the pre-HAART era is poorly documented.

Methods:  From the French Hospital Database on HIV, we compared incidences of new AIDS-defining events among HIV-infected patients with a low CD4 count (< 200 cells/mm3) in 2 cohorts of pre-HAART era (1992 to 1994):  without treatment (Gp1), and on monotherapy (Gp2); and 3 HAART-treated cohorts (2000 to 2002):  HAART interruption (Gp3), detectable (Gp4), or undetectable plasma viral load (< 500 copies/mL) while on HAART (Gp5). AIDS-defining events incidence rates (events/100 person-years) were determined among each group for different CD4 count stratum:  £ 50, 50 to 100, and 100 to 200 cells/mm3. Multivariate analyses were performed using Cox models with counting process.

Results:  Overall, estimated incidence rates were significantly higher in pre-HAART era vs HAART era and incidence rates significantly decreased from Gp3 to Gp5 (p < 0.0001). Incidence rates were significantly higher among patients without treatment (p < 0.0001) or on monotherapy (p < 0.0001) compared with patients on HAART interruption. However, overall and in patients with CD4 cells £ 50 mm3, incidence rates were significantly lower among patients with detectable (p < o.0001) or undetectable viral load (p < 0.0001) than in patients on HAART interruption. After adjustment for baseline characteristics (gender, age, AIDS status, and HIV transmission group) and time-dependant continuous variables (CD4 stratum), estimated risks (hazard ratios) of AIDS-defining events occurrence were:  1.06 (95% CI 0.90 to 1.25), 1.22 (1.05 to 1.43), 0.60 (0.51 to 0.71), and 0.34 (0.27 to 0.43) for Gp1, 2, 4, and 5 respectively, compared with Gp3.

         * p value corresponding to the comparison of each group vs Gp3.

 

Conclusions: Even among patients with immunologic and virologic failure, maintenance of HAART protects from AIDS-defining events.

Keywords: AIDS-defining events (ADE); highly active antiretroviral therapy (HAART); CD4 count