Favourable evolution of virological and immunological profiles in treated and untreated patients in Italy in the period 1998-2008

Abstract

BackgroundThis study provides an estimate of the proportion of HIV-positive patients in Italian clinics showing an 'adverse prognosis' (defined as a CD4 count 200 cells/mL or an HIV RNA 450 HIV-1 RNA copies/mL) over time, and investigates whether this proportion varied according to patients' characteristics. MethodsWe estimated the annual proportion of patients with a CD4 count 200 cells/mL or HIV RNA 450 copies/mL out of the total number of patients in the Icona Foundation cohort seen in any given year, both overall and after stratifying by demographical and treatment status groups. Generalized estimating equation models for Poisson regression were applied. ResultsIn 1998-2008, the prevalence of patients with a CD4 count 200 cells/mL decreased from 14 to 6% [adjusted relative risk (RR) 0.86/year; 95% confidence interval (CI) 0.84-0.88; Po0.0001]. The prevalence of HIV RNA 450 copies/mL decreased from 66 to 40% (adjusted RR 0.95/year; 95% CI 0.95-0.96; Po0.0001) in all patients and from 38 to 12% in the subgroup of patients who had previously received antiretroviral therapy (ART) for 6 months (adjusted RR 0.89/year; 95% CI 0.88-0.90; Po0.0001). ConclusionsThere was a substantial increase in the success rate of ART in Italy in 1998, resulting in a lower percentage of patients with adverse prognosis in recent years. The use of ART seemed to be the most important determinant of viral load outcome, regardless of mode of transmission. Although injecting drug users showed a less marked improvement in CD4 cell count over time than other risk groups, they showed a similar improvement in detectable viral load. IntroductionIn the decade (1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008) since the introduction of combination antiretroviral therapy (cART), the rates of AIDS-related deaths and pathological events have dramatically decreased in Western Europe [1]. The declining trends over time in the prevalence of immunosuppression Correspondence: Dr Mattia C. F. Prosperi, Clinic of Infectious Diseases, Catholic University of the Sacred Heart, Largo F. Vito, 1, 00146 Rome, Italy. Tel: 1 39 338 259 6115; e-mail: ahnven@yahoo.it *See Appendix. DOI: 10.1111/j.1468-1293.2010.00866.x HIV Medicine (2011 r 2010 British HIV Association 174 and detectable viraemia [2,3] reflect the impact of the successful use of cART, together with increases in drug uptake [4]. The best predictor of disease progression is the current absolute CD4 cell count, but the patient's age, current HIV RNA viral load (VL) and pre-ART AIDS diagnoses have also been shown to play a significant role in disease progression [5,6]. Populations of HIV-infected individuals are composed of subgroups with different demographics, and it remains unclear whether virological outcomes vary according to patients' mode of HIV acquisition, possibly because of differences in the level of adherence to ART [7]. In addition, different ethnic groups may have different opportunities to access medical care [8]. Other factors, such as hepatitis coinfections and centre...

Virological effectiveness and CD4+ T-cell increase over early and late courses in HIV infected patients on antiretroviral therapy: focus on HCV and anchor class received

“…Regarding the other predictors of virological success, the positive impact of aging (possibly reflecting better adherence in older patients) is not new [23,24], as well as the positive impact of more recent calendar years, possibly reflecting a significant improvement in the drug regimens and in the overall standard of care [25,26]. …”

Efficacy of 1998 Vs 2006 First-Line Antiretroviral Regimens for HIV Infection: An Ordinary Clinics Retrospective Investigation

“…Reports from the ICONA cohort showed that there was a significant increase in ART success rates in Italy between 1998 and 2008 [33]. Patients with CD4 T-cell counts ≤ 200/mm 3 decreased from 14 to 6% and the prevalence of HIV-RNA >50 copies/mL similarly decreased from 60% to 40% [33].…”

“…Reports from the ICONA cohort showed that there was a significant increase in ART success rates in Italy between 1998 and 2008 [33]. Patients with CD4 T-cell counts ≤ 200/mm 3 decreased from 14 to 6% and the prevalence of HIV-RNA >50 copies/mL similarly decreased from 60% to 40% [33]. The HIV Swiss cohort study reported 1-year incremental improvements in outcomes between the 2000 -2001 and 2004-2005 time intervals, both for patients with plasma HIV RNA <50 copies/mL and for CD4 T-cell count gains at 1 year of treatment [19].…”