AEGiS-14IAC: The prognostic significance of basal CD4 cell counts on immunologic and virologic responses to antiretroviral therapy (ART) in AIDS patients.

14th International AIDS Conference

Barcelona, Spain - July 7-12, 2002

The prognostic significance of basal CD4 cell counts on immunologic and virologic responses to antiretroviral therapy (ART) in AIDS patients.

Int Conf AIDS 2002 Jul 7-12; 14:(abstract no. B10205)

Ranin JT, Salemovic D, Zerjav S, Jevtovic DJ
Institute for Infectious and Tropical Diseases, KCS, Belgrade, Yugoslavia

BACKGROUND: The majority of HIV infected patients in Yugoslavia have severe immunodeficiency on presentation. We examined the possibility to achieve complete suppression of viral replication and immune reconstitution in these patients after ART.

METHODS: Using an electronic database, a study of a cohort of 195 patients regularly followed-up in our HIV unit was done to evaluate the efficacy of HAART. The basal CD4 cell count was below 100/mm³ in 59% of patients. 93% of patients were on HAART, of which 80% on PI regimens. The CD4 cell counts as parameters of immune reconstitution were assessed at two values: a count of≥400 along with the pVL of less than 50 copies/ml was considered as the most desirable response, and a count of≥200 (regardless of the virologic response) as minimal efficacy. The follow-up time was 28.5±15.8 mo.

RESULTS: Multivariant logistic regression analysis showed that basal CD4<100 was the best negative predictor (OR 0.2, 95%CI 0.1-0.5) of a desirable virologic and immunologic response, while basal CD4>100 had a positive predictive value (OR 3.6, 95%CI 1.7-7.7). Thus, in patients with basal CD4>100 there was a greater likelihood of CD4s rising above 200 (OR 5.0, 95%CI 1,8-13.0). Treatment-wise, in the subgroup of patients with basal CD4<100, minimal efficacy was unlikely to be achieved with drug regimens not containing PIs (OR 0.1, 95%CI 0.01-0.9). In contrast, among patients whose basal CD4>100, both PI-containing regimens and those without PI were equally effective (P= 0.17, log rank test).

CONCLUSION: Complete suppression of viral replication and immunologic reconstitution was less likely to be achieved in patients with basal CD4<100, especially if HAART regimens without PIs were used. However, in patients with pretreatment CD4>100 it was possible to escape from the risk zone for developing opportunistic infections with triple therapy not containing PIs.

Keywords: AEGIS, CD4 Lymphocyte Count, Antiretroviral Therapy, Highly Active, Acquired Immunodeficiency Syndrome, HIV Infections, HIV Seropositivity, Drug Therapy, Combination, Yugoslavia, Human, virology, immunology, therapy, Diagnosis, drug therapy

020707
B10205