PLoS ONE (Jan 2014)

Immuno-virological discordance and the risk of non-AIDS and AIDS events in a large observational cohort of HIV-patients in Europe.

  • Alexander Zoufaly,
  • Alessandro Cozzi-Lepri,
  • Joanne Reekie,
  • Ole Kirk,
  • Jens Lundgren,
  • Peter Reiss,
  • Djordje Jevtovic,
  • Ladislav Machala,
  • Robert Zangerle,
  • Amanda Mocroft,
  • Jan Van Lunzen,
  • EuroSIDA in EuroCoord

DOI
https://doi.org/10.1371/journal.pone.0087160
Journal volume & issue
Vol. 9, no. 1
p. e87160

Abstract

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BACKGROUND: 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 CD4500 copies/mL were followed-up from the first day of VLgrade 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.