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Patients presenting with AIDS in the HAART era: a collaborative cohort analysis

Mussini, Cristinaa; Manzardo, Christianb; Johnson, Margaretc; Monforte, Antonella d'Arminiod; Uberti-Foppa, Caterinae; Antinori, Andreaf; Gill, M Johng; Sighinolfi, Laurah; Borghi, Vannia; Lazzarin, Adrianoe; Miró, José Mb; Sabin, Carolinei; on behalf of the Late Presenter Investigators

doi: 10.1097/QAD.0b013e328314b5f1
Clinical Science

Objective: Many patients infected with HIV still present with an AIDS diagnosis. The aim of this study was to evaluate the virological, immunological and clinical outcomes of HAART in these patients.

Design: The present study was a multi-cohort study. All patients with an AIDS diagnosis between 30 days before and 14 days after HIV diagnosis, recruited between 1997 and 2004 from eight hospital cohorts, were evaluated.

Results: A total of 760 patients were included [268 (35.3%) had pneumocystis and 168 (22.1%) tuberculosis]. Six hundred and twenty-four patients (82.1%) started HAART a median of 31 days after HIV diagnosis. One hundred and fifty-three patients started a nonnucleoside transcriptase inhibitor-based regimen (20.1%), 409 a protease inhibitor-based regimen (53.8%) and 62 other regimens (8.2%). In adjusted analyses, HAART was started sooner in more recent years, in patients with lower CD4 cell count and in those with Kaposi's sarcoma, whereas it was started later in those with tuberculosis. Five hundred and five patients (89%) attained a viral load of less than 500 copies/ml. The factors associated with a better virological response were later calendar year, lower initial viral load and cytomegalovirus disease. Virological rebound was more common in those receiving nucleoside reverse transcriptase inhibitor-based regimens, in those with tuberculosis and in earlier calendar years. One hundred and twenty-five (16%) patients died; 61 had received HAART (48.6%). Mortality was more likely in those who were older, those with a higher viral load at diagnosis, those with nonsexual HIV risks and those with lower CD4 cell count and haemoglobin levels over follow-up.

Conclusion: Virological suppression was achieved in most AIDS patients, though mortality remains high in these individuals.

aClinic of Infectious and Tropical Diseases, University of Modena and Reggio Emilia, Modena, and Azienda Policlinico, Modena, Italy

bHospital Cliníc-IDIBAPS, University of Barcelona, Barcelona, Spain

cIan Charleson Centre, Royal Free Hospital, London, UK

dClinic of Infectious Diseases, San Paolo University Hospital, Italy

eClinic of Infectious Diseases, Università Vita e Salute, Milan, Italy

fNational Institute for Infectious Diseases ‘L. Spallanzani’, IRCCS, Rome, Italy

gSouthern Alberta Clinic, Calgary, Canada

hDepartment of Infectious Diseases, S. Anna Hospital, Ferrara, Italy

iRoyal Free Centre for HIV Medicine, Research Department of Infection and Population Health, Division of Population Health, Royal Free & University College Medical School, London, UK.

* A full list of all study contributors is provided in the Acknowledgements.

Received 19 June, 2008

Revised 28 July, 2008

Accepted 6 August, 2008

Correspondence to Dr Cristina Mussini, Clinic of Infectious and Tropical Diseases, Azienda Policlinico, University of Modena and Reggio Emilia, Via del Pozzo 71, 41100 Modena, Italy. Tel: +39 059 422 4119; fax: +39 059 422 2604; e-mail: crimuss@unimo.it

© 2008 Lippincott Williams & Wilkins, Inc.