[TuPe1.1C15] Stratification of risk for mortality by baseline CD4 cell counts in hepatitis C positive and negative individuals initiating highly active antiretroviral therapy (HAART)

3rd International AIDS Society Conference on HIV Pathogenesis and Treatment

Rio de Janeiro - July 24 - 27, 2005

STRATIFICATION OF RISK FOR MORTALITY BY BASELINE CD4 CELL COUNTS IN HEPATITIS C POSITIVE AND NEGATIVE INDIVIDUALS INITIATING HIGHLY ACTIVE ANTIRETROVIRAL THERAPY (HAART)

IAS Conf HIV Pathog Treat 2005 Jul 24-27;3rd: Abstract No. TuPe1.1C15

Moore D.¹, Braitstein P.², Yip B.¹, Montaner J.¹, Hogg R.¹
¹BC Centre for Excellence in HIV/AIDS, Vancouver, Canada, ²University of Bern, Bern, Switzerland

OBJECTIVE: To determine whether the stratification of non-accidental mortality by baseline CD4 counts is similar for HCV positive and negative individuals initiating HAART.

METHODS: Participants who were treatment naïve, who initiated HAART between August 1, 1996 and June 30, 2002, and had documented HCV serology were included in the study. Data were censored at June 30, 2003. HCV positive and negative individuals were stratified by baseline CD4 counts of 50 cell/ µL increments. Survival analysis was used to determine which strata were associated with an increased risk of mortality. Where hazard ratios were similar between strata, these were aggregated. Cox-proportional hazards regression was then used to model the effect of these derived strata with other prognostic variables on survival.

RESULTS: A total of 673 (48.3%) HCV antibody-positive and 721 (51.7%) HCV antibody-negative subjects were included. Crude mortality in HCV positives was 18.1% and 8.6% in HCV negative subjects (p<0.001). CD4 strata below 200 cells/ µL, but not above, imparted an increased risk of mortality for both HCV positive and negative individuals. Among HCV-positive individuals, after adjustment for baseline age, HIV RNA levels, history of injection drug use and adherence to therapy, CD4 cell count strata of <50 cells/ µL (RH=4.60; 95% CI 2.72 - 7.76) and 50 - 199 cells/ µL (RH=2.49; 95% CI 1.63 - 3.81) were significantly associated with increased mortality. HCV negative individuals had similar risks of mortality with baseline CD4 counts below 50 cells/ µL (RH=3.77; 95% CI 1.91 - 7.48) and 50 - 199 cells/ µL (RH=2.05; 95% CI 1.09 - 3.83) after adjustment.

CONCLUSIONS: Baseline CD4 strata which are associated with increased non-accidental mortality appear to be similar for HCV negative and HCV positive receiving HAART, suggesting no benefit to earlier treatment of HCV positive individuals.

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050724
Clinical | TuPe1.1C15 | David Moore
Hepatitis viruses

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