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Association of virus load, CD4 cell count, and treatment with clinical progression in human immunodeficiency virus-infected patients with very low CD4 cell counts

par Miller, Veronica;Hermans, Philippe ;Sommereijns, Bernadette; [et al.]
Référence The Journal of infectious diseases, 186, 2, page (189-197)
Publication Publié, 2002-07

Article révisé par les pairs

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Résumé :

This study prospectively assessed the impact of treatment modality, virus load, and CD4 cell count of <50 cells/mm3 on human immunodeficiency virus disease progression. The incidence rate of new AIDS disease or death was 54.8 (95% confidence interval, 48.7-59.9) per 100 person-years of follow-up. Independent predictors related to progression were latest CD4 cell count (relative risk [RR], 0.84/10 mm3 higher; P < .0001), latest hemoglobin level (RR, 0.79/g/L higher; P < .0001), Pneumocystis carinii pneumonia prophylaxis (RR, 0.49; P < .0001), latest body mass index (RR, 0.93/kg/m2 higher; P = .002), latest virus load (RR, 1.11/log10 higher; P = .03), and intensity of treatment (RR, 1.82, P = .004; RR 2.27, P < .0001; RR 2.46, P = .0001; RR 2.33 P < .0006;5.10, P < .0001, respectively, for 4, 3, 2, 1, or no drugs vs. ≥5 drugs). Although reverse causality cannot be excluded, more intense antiviral treatment appears to decrease the risk of progression in immunocompromised patients.