Long-term complications in patients with poor immunological recovery despite virological successful HAART in Dutch ATHENA cohort

• Published in: AIDS (London) Vol. 26; no. 4; pp. 465 - 474
• Main Authors: VAN LELYVELD, Steven F. L, GRAS, Luuk, KESSELRING, Anouk, SHUANGJIE ZHANG, DE WOLF, Frank, WENSING, Annemarie M. J, HOEPELMAN, Andy I. M
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 20.02.2012
• Subjects: Acquired Immunodeficiency Syndrome - complications; Acquired Immunodeficiency Syndrome - immunology; Acquired Immunodeficiency Syndrome - mortality; Adult; Age Factors; AIDS/HIV; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antiretroviral Therapy, Highly Active; Antiviral agents; Biological and medical sciences; Cardiovascular Diseases - etiology; Cardiovascular Diseases - immunology; Cardiovascular Diseases - mortality; CD4 Lymphocyte Count; Cohort Studies; Disease Progression; Female; Human immunodeficiency virus; Human viral diseases; Humans; Immunodeficiencies; Immunodeficiencies. Immunoglobulinopathies; Immunopathology; Infectious diseases; Male; Medical sciences; Middle Aged; Neoplasms - etiology; Neoplasms - immunology; Neoplasms - mortality; Netherlands - epidemiology; Pharmacology. Drug treatments; Retrospective Studies; RNA, Viral - drug effects; Treatment Outcome; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Viral Load - drug effects; Netherlands; Europe; Cardiovascular disease; Immunological investigation; T-Lymphocyte; Antiviral; Complication; Tumor; Human; Immunopathology; Retroviridae; Immune reconstitution; AIDS; cardiovascular diseases; Immune deficiency; Lentivirus; Long term; Infection; Virus; Chemotherapy; Treatment; HIV; CD4 lymphocyte count; Viral disease; Human immunodeficiency virus; neoplasms; HAART
• ISSN: 0269-9370; 1473-5571
• DOI: 10.1097/QAD.0b013e32834f32f8

We investigated the risk of AIDS and serious non-AIDS-defining diseases (non-ADDs) according to the degree of immunological recovery after 2 years of virological successful antiretroviral therapy (HAART). Retrospective observational cohort study including HIV-infected patients treated with HAART resulting in viral suppression (<500 copies/ml). Patients were grouped according to their CD4 cell count after 2 years of HAART: CD4 cell count less than 200 cells/μl (group A), 200-350 cells/μl (group B), 351-500 cells/μl (group C) or more than 500 cells/μl (group D). Analysis was done to assess predictors for poor immunological recovery and the occurrence of a composite endpoint [death, AIDS, malignancies, liver cirrhosis and cardiovascular events (CVEs)], non-ADDs, CVEs and non-AIDS-defining malignancies (non-ADMs). Three thousand and sixty-eight patients were included. Older age, lower CD4 cell nadir and lower plasma HIV-RNA at the start of HAART were independent predictors for a poor immunological recovery. The composite endpoint, non-ADDs and CVE were observed most frequently in group A (overall log rank, P < 0.0001, P = 0.002 and P = 0.01). In adjusted analyses, age was a strong independent predictor for all endpoints. Compared with group A, patients in group D had a lower risk for the composite endpoint [hazard ratio 0.54 (95% confidence interval [CI] 0.33-0.87]; patients in group B had a lower risk for CVEs [hazard ratio 0.34 (95% CI 0.14-0.86)]. Poor immunological recovery despite virological successful HAART is associated with a higher risk for overall morbidity and mortality and CVEs in particular. This study underlines the importance of starting HAART at higher CD4 cell counts, particularly in older patients.