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Incidence and risk factors of non AIDS-defining as compared with AIDS-defining infections and cancers in a cohort of HIV-infected patients initiating a protease inhibitor -containing regimen



Incidence and risk factors of non AIDS-defining as compared with AIDS-defining infections and cancers in a cohort of HIV-infected patients initiating a protease inhibitor -containing regimen



Abstracts of the Interscience Conference on Antimicrobial Agents & Chemotherapy 41: 320



Background: As opposed to progression to AIDS and death, the incidence and risk factors of non AIDS-related infections and cancers have rarely been studied in the HAART era. Methods: APROCO cohort enrolled 1,281 pts at the initiation of a PI-containing regimen. We analyzed the incidence of AIDS-defining (ADIC) and non AIDS-defining (non-ADIC) infections and cancers occurring after the first 4 mo of HAART and studied the risk factors for each event using multivariate Cox models including CD4+ cell counts and plasma HIV RNA as time-dependent variables. Results: At baseline, 20% of pts had AIDS and 35% had CD4<200/mm3. Median follow-up was 24 mo. Incidence of ADIC (n=43; 2.3/100 pts-yrs) and non-ADIC (n=40; 2.1/100 pts-yrs) was similar. The most frequent non-ADIC were bacterial pneumonia (n=21), septicemia (n=7), cancer (n=4) and Hodgkin's disease (n=3). Non-ADIC were associated with age (HR=1.6/10 yrs older, p<0.01), most recent CD4<100/mm3 (HR=3.4; p=0.01) and HIV RNA>10,000 c/ml (HR=3.7; p<0.001). ADIC were less frequent in pts with higher level of education (hazard ratio (HR)=0.3; p=0.02) and were associated with previous AIDS (HR=3.6; p<0.0001), most recent CD4<100 (HR=8.7; p<0.0001) or between 100 and 200/mm3 (HR=3.1; p=0.01) and HIV RNA>50,000 c/ml (HR=6.8; p<0.0001). Naivete, type of HAART and infection with HCV or HBV were not associated with occurrence of ADIC or non-ADIC. Conclusion: Infections and cancers, whatever AIDS-related or not, are rare after the first 4 months of HAART and associated with severe immunologic and/or viral failure. Pts with high level of education may be at lower risk of progression.

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