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8th Annual Conference Of The British HIV Association [BHIVA]19 – 21 April 2002, University of York, York |
[AUTHOR(S):] JR Deayton, CA Sabin, MA Johnson, VC Emery, PD Griffiths
Royal Free and University College School of Medicine, Royal Free Campus, London
BHIVA Conf 2002 Apr 19-21;8:O26
OBJECTIVE: To investigate whether CMV viraemia remains independently associated with disease progression and survival in the era of HAART.
METHODS: All patients whose CD4 count had ever been below 100 cells/µL were prospectively monitored for CMV viraemia by qualitative polymerase chain reaction (PCR); this was continued even if CD4 levels increased after HAART. End points were progression to a new AIDS event, new CMV disease and death.
RESULTS: 390 patients were studied for a median of 36 months. Progression to a new AIDS event was significantly associated with CD4 count [relative hazard (RH) 1.08] and HIV load (RH 1.28) but more strongly associated with CMV viraemia (RH 2.34). CMV viraemia was strongly associated with progression to CMV disease (RH 32.01). CMV viraemia was associated with an increased risk of death with a progression rate of 20.4% in viraemic patients compared with 8.2% in non-viraemic individuals (P=0.003). The RH of death associated with CMV viraemia was 4.23, and 1.18 for the CD4 count. HIV load was not associated with CMV disease or death in time-updated models.
CONCLUSIONS: CMV viraemia is independently associated with disease progression and death in the era of HAART and is more strongly correlated with risk of death than CD4 count or HIV load. CMV viraemia appears to be a more sensitive predictor of prognosis than other markers and may thus provide a marker for sustained immune function after HAART. Short-term changes in CMV PCR status are important for prognosis, suggesting that treatment of CMV viraemia should be evaluated in a placebo-controlled trial.
PRESENTING AUTHOR: JR Deayton
020419
O26
Copyright © 2002 - British HIV Association (BHIVA) Reproduction of this abstract (other than one copy for personal reference) must be cleared through the BHIVA Organising Secretariat 1 Mountview Court, 310 Friern Barnet Lane, London N20 0LD