[TuOrB1140] Prognosis of HIV-1 infected drug naiuml;ve patients starting potent antiretroviral therapy. ART Cohort Collaboration

14th International AIDS Conference

Barcelona, Spain — July 7-12, 2002

[TITLE:] Prognosis of HIV-1 infected drug naiuml;ve patients starting potent antiretroviral therapy. ART Cohort Collaboration

[AUTHOR(S):] G Chene¹, M May², D Costagliola³, A dArminio Monforte⁴, C Junghans⁵, F de Wolf⁶, J D Lundgren⁷, G Fusco⁸, V Miller⁹

Int Conf AIDS. 2002 Jul 7-12;14:Abstract No. TuOrB1140

BACKGROUND: Prognosis in the era of HAART is ill defined. The ART Cohort Collaboration aims to estimate progression rates to AIDS or death, and death, in drug-naïve patients starting therapy.

METHODS: 13 HIV cohort studies (10 Europe, 2 Canada, 1 US) participated. We included adult drug naïve patients starting HAART with > 3 drugs (NRTI, PI, or NNRTI). Data were analysed by intent to treat (ignoring changes/ interruptions) using KM life tables and Cox regression. Non parametric prognostic models were developed (see also May et al, Sterne et al).

RESULTS: 12574 individuals were included. Baseline characteristics were: mean age 40 yrs, women 21%, clinical stage C 21%, MSM 41%, IDU 19%. The median baseline CD4 count was 250 cells/ul, log viral load (VL) 4.9 copies/ml. There were 870 AIDS events and 344 deaths during 24310 years of follow up. The figure shows KM probabilities for AIDS or death by VL and CD4 count measured at baseline and 6 months. Age >50 yrs, history of IDU and stage C were also predictive. In prognostic models rates to AIDS or death at 3 yrs ranged from 3.3% (95% CI 2.7-4.1) to 41.7% (35.2-58.9), to death from 0.8% (95% CI 0.5-1.2) to 36.2% (27.2-47.1). In stage A/B patients with VL <5, prognosis was similar in groups with CD4 cells >350 and 200-349. For example, in patients <50 yrs and no history of IDU, 3-yr probabilities of AIDS or death were 3.3% (95% CI 2.7-4.1) and 4.5% (3.7-5.5), respectively. Rates of AIDS or death at 3 years predicted from 6 month measurements ranged from 3.0% (2.3-3.7) to 86.9% (74.6-95.1) and for death from 0.9% (0.6-1.3) to 83.3% (65.0-95.2).

CONCLUSIONS: Prognosis after initiating HAART varies widely depending on the CD4 count at baseline and at 6 months. Baseline VL is not predictive unless >5 log. At 6 months, however, VL is predictive at all levels. Our findings should help decide when to initiate and modify HAART and inform relevant guidelines.

Presenting author: G Chene

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1G Chene; ART Cohort Collaboration, Department of Social Medicine, Canynge Hall, Whiteladies Road, Bristol BS8 2PR, France

2M May; ART Cohort Collaboration, University of Bristol, United Kingdom

3D Costagliola; ART Cohort Collaboration, University of Bristol, United Kingdom

4A dArminio Monforte; ICONA, University of Milan, Italy

5C Junghans; Swiss HIV Cohort Study, University of Bristol, United Kingdom

6F de Wolf; ATHENA, University of Amsterdam, The Netherlands

7J D Lundgren; EuroSIDA, University of Copenhagen, Denmark

8G Fusco; CHORUS, GlaxoSmithKline, United States

9V Miller; Frankfurt HIV Cohort, University of Frankfurt, Germany

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