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14th Annual Conference of the British HIV Association23–25 April 2008, Belfast |
RESPONSES TO HAART AND CLINICAL EVENTS IN PATIENTS WITH A LOW CD4 COUNT: LATE PRESENTERS VERSUS LATE STARTERS
HIV Med 2008 Apr 23-25 (Suppl 1);14:4 (abstract no. O12)
LJ Waters1, MJ Fisher2, J Anderson3, C Wood4 and C Sabin5, for the UK CHIC Study Group5
1Chelsea and Westminster Hospital, London, UK, 2Royal Sussex County Hospital, Brighton, UK, 3Homerton University Hospital, London, UK, 4North Middlesex Hospital, London, UK, 5Royal Free and UC Medical School, London, UK
BACKGROUND: One in three UK patients present late (CD4 <200) which has been associated with higher morbidity/mortality. Previous cohort analyses may be confounded by additional factors associated with late presentation. If so outcomes for late presenters may differ from those who present earlier but start therapy late.
METHODS: We identified ARV-naïve adults starting HAART (NRTI + NNRTI or PI/r) with ≥1 pre-HAART CD4 and baseline VL>500. Those presenting with CD4 >350 were stratified by CD4 at HAART (<200 [grp 2], 200-350 [grp 3], >350 [grp 4]) and compared with those presenting and starting HAART <200 [grp 1]. 48 week CD4 and VL outcomes were compared by multivariable analysis including demographics and HAART type.
RESULTS: Five thousand and three patients were eligible for analysis with 2511,790,1004 and 698 in groups 1–4 respectively. 74.6% were male, 53.2% homosexual and 55.7% white. Most started NNRTI-based HAART but more individuals starting HAART with CD4 >350 commenced a PI. By 48 weeks more in grp 1 had a new AIDS event (8.8% versus 4.9%, 2.8% & 1.6% in grps 2-4; p=0.0001 for grp 1 versus 2) or death (2.4% versus 1.3%, 0.6% & 0.1%; p=0.07 for grp 1 versus 2). CD4 rises at 48 weeks in grp 1–4 were 160,190,192 & 131 respectively (p<0.0001 overall; p=0.0001 & 0.01 for grp 1 versus 2 by uni and multivariate analysis respectively). VL suppression rates at 48 weeks were 81.4%,82.7%, 86.5% & 76.4% across groups 1-4 (p=0.0006 overall;p=0.55 for grp 1 versus 2).
CONCLUSIONS: Late presenters achieve similar rates of viral suppression to subjects who present early but start HAART with CD4 <200 but CD4 rise is significantly less at 48 weeks. New AIDS events were significantly more common for late presenters versus late starters which may reflect factors, additional to CD4 count, associated with late presentation.
2008-04-23
O12
Copyright © 2008 - British HIV Association (BHIVA) Reproduction of this abstract (other than one copy for personal reference) must be cleared through the BHIVA Organising Secretariat 1 Mountview Court, 310 Friern Barnet Lane, London N20 0LD