Clinical Outcome of HIV-Infected Patients with Sustained Virologic Response to Antiretroviral Therapy: Long-Term Follow-Up of a Multicenter Cohort

Abstract

BackgroundLimited information exists on long-term prognosis of patients with sustained virologic response to antiretroviral therapy. We aimed to assess predictors of unfavorable clinical outcome in patients who maintain viral suppression with HAART.MethodsUsing data collected from ten clinic-based cohorts in Spain, we selected all antiretroviral-naive adults who initiated HAART and maintained plasma HIV-1 RNA levels <500 copies/mL throughout follow-up. Factors associated with disease progression were determined by Cox proportional-hazards models.ResultsOf 2,613 patients who started HAART, 757 fulfilled the inclusion criteria. 61% of them initiated a protease inhibitor-based HAART regimen, 29.7% a nonnucleoside reverse-transcriptase inhibitor-based regimen, and 7.8% a triple-nucleoside regimen. During 2,556 person-years of follow-up, 22 (2.9%) patients died (mortality rate 0.86 per 100 person-years), and 40 (5.3%) died or developed a new AIDS-defining event. The most common causes of death were neoplasias and liver failure. Mortality was independently associated with a CD4-T cell response <50 cells/L after 12 months of HAART (adjusted hazard ratio [AHR], 4.26 [95% confidence interval {CI}, 1.68–10.83]; P = .002), and age at initiation of HAART (AHR, 1.06 per year; 95% CI, 1.02–1.09; P = .001). Initial antiretroviral regimen chosen was not associated with different risk of clinical progression.ConclusionsPatients with sustained virologic response on HAART have a low mortality rate over time. Long-term outcome of these patients is driven by immunologic response at the end of the first year of therapy and age at the time of HAART initiation, but not by the initial antiretroviral regimen selected.

Comparison of clinical and laboratory profile of Haart adherent and non-adherent HIV/AIDS patients in Calabar, Nigeria

“…These findings support the established fact of improvement in clinical condition of patients on HAART over time, as the mean duration on HAART for the cohort was 45.6 months (range from 6-133 months), which is enough time for evidence of clinical improvement (Ferradini, 2006). Furthermore, at this early clinical stage, development of opportunistic infections will be minimal, thus reducing HIV-related mortality and improving survival among the cohort (World Health Organization, 2010;Gutierrez et al, 2006). Using AACTG adherence measure, 26.4% of adherent respondents were stage 3 disease, and stage 3 disease is reported to independently predict HIV-related mortality (World Health Organization, 2010).…”

“…Akileswaran, et al, in a systematic review of HAART use in Africa reported improved clinical outcomes with optimal adherence in most studies reviewed (Akileswaran, 2005). This is in tune with the established role of HAART in significantly reducing viral load and increasing CD4 cell count, and thereby minimizing damage or insult to essential body cells and tissues, therefore retarding disease progression with improvement or restoration of immunity against opportunistic infections (Gross et al, 2006;Ferradini, 2006;Nieuwkerk and Oort, 2006;Gutierrez, 2006;Crum et al, 2006;Hart et al, 2010). The improved clinical outcome of adherent subjects in the present study may have been due to the fact that the cohorts were taking the medicines as revealed by the high rate of adherence and the effectiveness of the regimen.…”

“…Several studies in both developed and developing countries have reported that optimal adherence (≥ 95%) correlated with a viral load decrease, CD4 cell count increase, total lymphocyte counts, haemoglobin concentrations and higher survival rates (Gross et al, 2006;Ferradini, 2006;Nieuwkerk and Oort, 2006;Gutierrez, 2006;Tang et al, 2011;Shikuma et al, 2004;Esposito et al, 2008;Quaye and Addai-Mensah, 2011).Non-adherence has also been associated with increased viral load, emerging drug resistance, increased morbidity and mortality (Brinkhof et al, 2009;Gazzola et al, 2009;Bangsberg et al, 2007).There have been mixed results of adherence rates in Africa and specifically in Nigeria with most studies reporting optimal adherence rates (Peltzer, 2010;Chabikuli 2010;Ohene and Forson, 2009;Monjok et al, 2010;Akileswaran, 2005).…”

Altered Redox Regulation as Cofactor in Comorbidities and Accelerated Aging in HIV Infection Evolution and Antiretroviral Treatment

“…Many of these conditions are classically associated with normal aging process but appear to be occurring at an earlier age in HIV-infected persons. These conditions include premature onset of cardiovascular disease, neurocognitive disease, bone disease, and cancer [57][58][59][60].…”

“…However, recent studies have indicated a rise in prevalence of HIV-1-associated neurocognitive disorders and related side effects following the era of HAART [57].…”