AIDSWEEKLY Plus; Monday, August 1, 2005
Staff Medical Writers

In a recently published article, scientists in Australia conducted a study "to determine the factors associated with clinical progression (AIDS events and death) in antiretroviral-naive patients who have begun highly active antiretroviral therapy (HAART).

"HIV-infected patients naive to antiretroviral therapy were included in a prospective hospital-based cohort who began HAART between June 1996 and December 2001. Progression was explained by baseline characteristics using Cox proportional hazards models."

"Overall," said F. Bonnet and coworkers at the University of New South Wales in Darlinghurst, "data for 709 patients were analyzed.

"In multivariate analysis, factors associated with an increased risk of progression were CD4 count <50 cells/mcL [hazard ratio (HR)=13.0 (95% confidence interval 3.8-44.3)] and between 50 and 199 cells/mcL [HR=5.1 (1.6-16.3)], when compared with patients with CD4 count >350 cells/mcL; AIDS events before HAART prescription [HR 2.1 (1.2-3.7)]; COB count <400 cells/mcL [HR 1.8 (1.1-3.0)]; and older age [HR=1.2 by 10 years (1.0-1.5)]."

"In a second model including CD4 percentage, factors associated with progression were CD4<10% [HR=6.3 (2.2-17.9)] and 10%<CD4<15% [HR=4.2 (1.4-12.5)], when compared with patients with CD4>20%; CD8 count; AIDS events before HAART prescription; and older age," the authors reported.

"In a third model including the CD4:CD8 ratio," continued investigators, "factors associated with progression were CD4:CD8<15% [HR=8.2 (2.3-28.8)] and 15%<CD4:CD8<30% [HR=4.6 (1.3-16.0)], when compared with patients with CD4:CD8>45%; AIDS events before HAART prescription; and older age. The Akaike information criteria for model analysis were 803, 805 and 815, respectively."

Bonnet concluded, "Consideration of CD4 level in terms of CD4:CD8 ratio or CD4 percentage can be a good alternative to absolute CD4 count. Other prognostic factors such as older age, CD8 count <400 cells/mu L and AIDS events also have to be considered in the decision to initiate HAART."

Bonnet and colleagues published their study in HIV Medicine (Determinants of clinical progression in antiretroviral-naive HIV-infected patients starting highly active antiretroviral therapy. Aquitaine Cohort, France, 1996-2002. HIV Med. 2005 May;6(3):198-205.

For more information, contact F. Bonnet, University of New S Wales, St. Vincents Medical Center, Faculty Med, Level 2, 376 Victoria St., Darlinghurst, NSW 2010, Australia.

Publisher contact information for the journal HIV Medicine is: Blackwell Publishing, 9600 Garsington Rd., Oxford OX4 2DG, Oxon, England.

Keywords: Darlinghurst, NSW, Australia, HIV/AIDS, HAART, CD4 T Lymphocytes, CD4:CD8 Ratio, Prognostic Indicator.

This article was prepared by AIDS Weekly editors from staff and other reports.

Reference

Bonnet F, Thiebaut R, Chene G, et al., Determinants of clinical progression in antiretroviral-naive HIV-infected patients starting highly active antiretroviral therapy. Aquitaine Cohort, France, 1996-2002., HIV Med. 2005 May;6(3):198-205.

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