RESEARCH ARTICLE


Clinical Progression Rates by CD4 Cell Category Before and After the Initiation of Combination Antiretroviral Therapy (cART)



Marguerite Guiguet1, 2, *, Kholoud Porter3, Andrew Phillips4, Dominique Costagliola1, 2, Abdel Babiker3
1 INSERM U720, Paris, France
2 UPMC Paris 06 UMR S720, Paris, France
3 MRC Clinical Trials Unit, London, UK
4 Royal Free & University College Medical School, London, UK


Article Metrics

CrossRef Citations:
0
Total Statistics:

Full-Text HTML Views: 907
Abstract HTML Views: 760
PDF Downloads: 229
Total Views/Downloads: 1896
Unique Statistics:

Full-Text HTML Views: 433
Abstract HTML Views: 355
PDF Downloads: 153
Total Views/Downloads: 941



2008 Bentham Science Publishers Ltd.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.5/), which permits unrestrictive use, distribution, and reproduction in any medium, provided the original work is properly cited.

* Address correspondence to this author at the INSERM U720, Paris, France; E-mail: mguiguet@ccde.chups.jussieu.fr


Abstract

Objective

Rates of AIDS defining event (ADE), serious ADE and death by CD4 and HIV RNA categories before and after combination antiretroviral therapy (cART) initiation are lacking for high CD4 counts.

Methods

Event rates were estimated within CD4 cell strata using a Poisson regression model adjusting for sex, exposure category, age, and current HIV RNA (<4, 4-4.99, ≥5 log copies/ml), and including an interaction term between the CD4 cell count and cART indicator.

Results

7317 and 6376 persons contributed to "naïve " and "cART " groups respectively, of whom 3911 contributed to both. At the same CD4 level, the risk of ADE was nearly 2 fold higher during naive follow-up compared to cART for CD4 <500 cells/mm3. However, after adjustment for current HIV RNA, the risk of ADE became similar for both groups except for CD4 count <200 cells/mm3 when it is 35% (6-72%) higher for naives. The same results were observed for the risk of serious ADE. There was no evidence of a difference in risk of death between naive and cART follow-up at specific CD4 categories even after adjustment for HIV RNA.

Conclusion

Within CD4 cell strata above 200 cells/mm3, the risk of ADE before ART initiation is higher than it is following cART initiation.

Keywords: Disease progression, CD4, cART, event rates, prognostic value.