Immmune recovery in treatment-naïve patients under HAART according to baseline CD4 count: the Chilean AIDS Cohort (ChiAC) experience
Abstract number: 1733_1407
Aranciabia J., Gallardo D., Beltrán C., Morales O., Wolff for the Chilean AIDS Group M.
Background: Immune recovery is one of the achievable goals of modern antiretroviral therapy (HAART) and is measured through CD4 counts which increase after successful viral suppression. The magnitude of recovery also seems to depend on baseline (BL) CD4 count, the higher the later, the better the results. Present guidelines recommend treatment before severe immunosuppresion is present but many patients begin HAART with CD4 levels much lower than the recommended due to advanced disease at diagnosis.
Objective: To evaluate the rate of immune recovery in treatment naïve pts (TxN) initiating HAART at various levels of clinical and immunologic disease cared for in the Chilean Public Health System and followed by the ChiAC.
Methods: ChiAC has 4,500 pts under follow up, 52% TxN who initiated HAART between 10/2001 and 01/2004. Results from 2,429 TxN with information updated to 08/2006, with an average follow up period of 3.5 years were available. Variables studied were BL CD4 and CDC clinical staging, (A, B and C) HAART regimens and results. CD4 response was compared according to BL CD4 (Group [G] 1: 0100, G2: 101200 and G3: 201300/mm3) both in absolute number (median) and slope and CDC BL clinical stage; CD4 results were measured every 6 months; Patients on HAART with BL CD4 > 300/mm3 were excluded; for statistical analysis SPSS 14 was used.
Results: At the beginning of HAART the number of patients in G1 was 1106; in G2, 712 and in G3, 304. Median baseline CD4 counts for each group were: 36 (SD ±29.0), 151 (SD ±28.4) and 232 (SD ±27) cells/mm3, respectively for groups 1, 2, and 3. Median CD4 rise were 137, 125, 188, 242 and 260 cells/mm3, at 0.5, 1, 2, 3 and 4 years of treatment respectively for G1; 69, 95, 193 and 239 cells/mm3 for G2, and 72, 74, 148, 228, 280 cells/mm3 for G3, respectively for these periods. The higher the BL CD4 the higher the CD4 rise over time but the slopes of the CD4 rise curves were comparable between groups. There was no difference in CD4 rise according to BL clinical status.
Conclusions: CD4 rise after successful HAART in treatment naïve pts was obtained at different levels of BL CD4 count, without significant difference according to BL clinical staging or viral load. The magnitude of the rise but not its rate is dependent on the BL CD4.
|Session name:||European Society of Clinical Microbiology and Infectious Diseases|
|Location:||ICC, Munich, Germany|
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