AEGiS-13IAC: Risk of progression to AIDS and death in HIV infected women initiating HAART at different stages of disease.

13th International AIDS Conference

Durban, South Africa - July 9-July 14, 2000

Risk of progression to AIDS and death in HIV infected women initiating HAART at different stages of disease.

Int Conf AIDS 2000 Jul 9-14; 13:(abstract no. TuOrB400)

Anastos K, Barron Y, Weiser B, Hessol N, Young M, Cohen M, Miotti P, Augenbraun M, Levine A, Munoz A
K. Anastos, Albert Einstein College of Medicine, 41 Lewis Parkway, Yonkers, NY 10705, United States, Tel.: +1 914 476 8675, Fax: +1 914 476 8677, E-mail: kanasto@aol.com

OBJECTIVES: To determine the factors associated with progression to AIDS or death with HAART initiation (HAART) at different immunologic, virologic and clinical stage.

METHODS: In 893 HIV infected women in the Women's Interagency HIV Study with a known date of initiating HAART (?6 mo). Time from HAART to AIDS and death by July 99 was analyzed by Cox regression. Prognostic factors included ethnicity, age, CD4, viral load (VL) and ART naivete at HAART.

RESULTS: Among 474 AIDS-free women at HAART, 44 developed AIDS and 18 died in a 2.2 yrs median follow-up. Compared to women with CD4 >350 at initiation, the relative hazards (RH) for progression with CD4 200-350 and >200 cells/mm³ were 1.06 (p = .89) and 2.89 (p = .004), respectively. However, Kaplan-Meier curves for the 2 higher CD4 categories diverged in the direction of better outcome after 1.5 yrs in those with CD4>350. Compared to VL>5K, the RH of progression with VL of 5K-50K and >50K copies/ml were 1.59 (p = .24) and 2.16 (p = .046) respectively. 60 women, 42 with pre-existing clinical AIDS, died. Survival after HAART was strongly associated with preceding AIDS diagnosis (RH = 3.2;p>.001). Among those with AIDS at initiation, the RH of death was ~ 2- and 4-fold greater with CD4 200-350, and >200 respectively, compared to CD4>350, and with VL 5-50K and >50K respectively. Age showed an upward trend for risk of AIDS. With only 10% ART-naive, a strong, but not statistically significant, protection from death (RH = .33) was shown. Ethnicity was not associated with disease progression or death.

CONCLUSIONS: Women initiating HAART at CD4 200-350 had similar progression to AIDS for 1.5 yrs. as women initiating at CD4>350, but may be more likely to progress thereafter. These results suggest that long-term follow-up (at least 3 yrs) is necessary to determine the benefit of initiating HAART at CD4>350, and underscore the role of long-term cohort studies to provide information on when to start HAART.

Keywords: AEGIS, Antiretroviral Therapy, Highly Active, Acquired Immunodeficiency Syndrome, HIV Infections, HIV Seropositivity, Viral Load, Disease Progression, Death, Longitudinal Studies, Human, Female, pathogenicity
000709
TuOrB400