AEGiS-14IAC: Long-term virologic and immunologic response to highly active antiretroviral therapy in community-based settings.

14th International AIDS Conference

Barcelona, Spain - July 7-12, 2002

Long-term virologic and immunologic response to highly active antiretroviral therapy in community-based settings.

Int Conf AIDS 2002 Jul 7-12; 14:(abstract no. C10685)

Touloumi G, Pantazis N, Sambatakou H, Sipsas N, Mangafas N, Katsarou O, Paparizos V, Antoniadou A, Gargalianos P, Kordossis T, Lazanas M, Karafoulidou A, Stavrianeas N, Giamarelou H, Hatzakis A
Dept Hygiene &Epidemiology, Athens Medical School, Athens, Greece

OBJECTIVE: To assess the predictors of long-term virologic and immunologic response to highly active antiretroviral therapy (HAART) in community-based settings.

METHODS: We studied 416 HIV-1 positive individuals (159 treatment-naïves) who initiated HAART and were enrolled in an multi-center observational study in Greece. Virologic response (VR) was defined as reducing HIV-RNA to below 500 Eq/ml and immunologic response (IR) as an increase in CD4 cell counts ≥100 cells/ é l from baseline, anytime after HAART initiation.

RESULTS: During a median follow-up time of 2.5 years (range: 3 months-4.6 years) 65% of the subjects achieved VR and 73.8% IR. The median time to VR and to IR was 4.8 and 6.4 months respectively. 32% of the subjects had discordance between VR and IR. Patients with lower baseline HIV-RNA levels and treatment naïve had higher probability of VR. Females tended to have higher probalilty of VR (relative hazard (RH): 1.37; 95% CI: 0.96-1.97; P=0,08). Patients starting HAART with a CD4 cell count below 200 cells/ é l had lower probability of IR but there was not significant difference in the probability of IR between subjects with baseline CD4 count 201-350 and >350 cells/ é l. Of those with an initial VR, 32% experienced subsequent virologic rebound. Probability of virologic rebound was higher in males, in those with NNRTIs as initial HAART and in treatment experienced subjects. For the majority (86%) of subjects with IR, CD4 cell counts continue to increase after the initial IR with the median increase per year being 45 (interquartile range: 22 to 71) cells/ é l. Subsequent increase in CD4 cell counts was higher in females and in treatment naïve subjects.

CONCLUSIONS: Virologic and immunologic response to HAART was stronger in treatment naïve subjects. Gender appeared to play a role in the subsequent virologic rebound and CD4 cell count change. Patients treated with NNRTIs may have higher rates of virologic rebound.

Keywords: AEGIS, Antiretroviral Therapy, Highly Active, CD4 Lymphocyte Count, HIV-1, HIV Infections, HIV Seropositivity, Greece, Human, Female, Male, virology, immunology

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