AEGiS-15IAC: Prognosis up to five years after initiating HAART: Collaborative analysis of prospective studies.

15th International AIDS Conference

Bangkok, Thailand - July 11-16, 2004

Prognosis up to five years after initiating HAART: Collaborative analysis of prospective studies.

Int Conf AIDS 2004 Jul 11-16; 15:(abstract no. TuOrC1157)

Egger M
On behalf of the ART Cohort Collaboration

BACKGROUND: The ART Cohort Collaboration was established to estimate the prognosis of HIV-1 infected, treatment naïve patients initiating highly active antiretroviral therapy (HAART).

METHODS: 12 cohorts currently participate in ART-CC: FHDH (France), ICONA (Italy), SHCS (Swiss), ATHENA (Dutch), EuroSIDA, CHORUS (USA), Frankfurt (Germany), Aquitaine (France), BCCfE (Canada), Royal Free (UK), South Alberta (Canada), Koln/Bonn (Germany). The database includes information on 19,086 adult treatment-naïve patients who started HAART with a combination of at least 3 drugs. We considered progression to a combined endpoint of a new AIDS-defining disease or death, and to death alone. We used the ART-CC prognostic model (Lancet 2002) to estimate probabilities of progression at 5 years.

RESULTS: During 55,307 person-years of follow up, 2,294 patients developed AIDS or died and 903 patients died. A low baseline CD4 cell count was strongly associated with progression to AIDS or death, whereas only a weak association was found with viral load. Older age, a history of IDU, clinical stage C and low haemoglobin levels at baseline were stronger risk factors for death than for progression overall. There was no effect of calendar year or gender. The probability of AIDS or death at 5 years ranged from 6.5% (5.7 to 7.4) in patients in the lowest-risk stratum for each prognostic variable to 74.0% (67.9 to 79.7) in patients in the highest-risk stratum. In patients free of AIDS with viral loads below 100,000 copies/mL, long-term prognosis was similar in patients starting HAART with CD4 cell counts of 350 cells/mL or greater and patients starting with 200 to 349 CD4 cells.

CONCLUSIONS: At the time of starting HAART, the CD4 cell count and haemoglobin level, but not viral load, are the dominant prognostic factors. Interestingly, we found no evidence that prognosis has improved over time. The data on long-term prognosis from this unique collaboration have important implications for clinical management and treatment guidelines.

Keywords: AEGIS, Antiretroviral Therapy, Highly Active, CD4 Lymphocyte Count, Prospective Studies, Viral Load, Acquired Immunodeficiency Syndrome, HIV-1, Prognosis, Risk Factors, Research, Treatment Outcome, France, Germany, Canada, Italy, Alberta, Adult, Humans

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TuOrC1157