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Title: Immuno-virological discordance and the risk of non-AIDS and AIDS events in a large observational cohort of HIV-patients in Europe
Author: Zoufaly, Alexander
Cozzi-Lepri, Alessandro
Reekie, Joanne
Kirk, Ole
Lundgren, Jens D.
Reiss, Peter
Jevtovic, Djordje
Machala, Ladislav
Zangerle, Robert
Mocroft, Amanda
Van Lunzen, Jan
Miró Meda, José M.
Gatell, José M.
Keywords: VIH (Virus)
Resposta immunitària
HIV (Viruses)
Immune response
Antiretroviral agents
Issue Date: 31-Jan-2014
Publisher: Public Library of Science (PLoS)
Abstract: The impact of immunosuppression despite virological suppression (immuno-virological discordance, ID) on the risk of developing fatal and non-fatal AIDS/non-AIDS events is unclear and remains to be elucidated. METHODS: Patients in EuroSIDA starting at least 1 new antiretroviral drug with CD4<350 cells/µl and viral load (VL)>500 copies/mL were followed-up from the first day of VL< = 50 copies/ml until a new fatal/non-fatal non-AIDS/AIDS event. Considered non-AIDS events included non-AIDS malignancies, pancreatitis, severe liver disease with hepatic encephalopathy (>grade 3), cardio- and cerebrovascular events, and end-stage renal disease. Patients were classified over time according to whether current CD4 count was above (non-ID) or below (ID) baseline level. Relative rates (RR) of events were calculated for ID vs. non-ID using adjusted Poisson regression models. RESULTS: 2,913 patients contributed 11,491 person-years for the analysis of non-AIDS. 241 pre-specified non-AIDS events (including 84 deaths) and 89 AIDS events (including 10 deaths) occurred. The RR of developing pre-specified non-AIDS events for ID vs. non-ID was 1.96 (95% CI 1.37-2.81, p<0.001) in unadjusted analysis and 1.43 (0.94-2.17, p = 0.095) after controlling for current CD4 count. ID was not associated with the risk of AIDS events (aRR 0.76, 95% CI 0.41-1.38, p = 0.361). CONCLUSION: Compared to CD4 responders, patients with immuno-virological discordance may be at increased risk of developing non-AIDS events. Further studies are warranted to establish whether in patients with ID, strategies to directly modify CD4 count response may be needed besides the use of ART.
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It is part of: PLoS One, 2014, vol. 9, num. 1, p. e87160
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ISSN: 1932-6203
Appears in Collections:Articles publicats en revistes (Medicina)

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