Clinical, immunological and virological evolution in patients with CD4 T-cell count above 500/mm3: is there a benefit to treat with highly active antiretroviral therapy (HAART)?
Fiche publication
Date publication
janvier 2004
Journal
European journal of epidemiology
Auteurs
Membres identifiés du Cancéropôle Est :
Pr BINQUET Christine, Pr QUANTIN Catherine, Pr KOHLI Evelyne
Tous les auteurs :
Piroth L, Binquet C, Buisson M, Kohli E, Duong M, Grappin M, Abrahamowicz M, Quantin C, Portier H, Chavanet P
Lien Pubmed
Résumé
To assess the clinical, immunological and virological evolution in HIV-1 infected patients with CD4 T-cell count above 500/mm3, a historical cohort of 202 untreated and 96 patients treated with HAART was longitudinally studied (median follow-up 36 months). Fourteen untreated and 2 treated patients experienced clinical progression (p = 0.09). The difference between baseline CD4 T-cell count and after 3 years, was -240/mm3 in the untreated group +19/mm3 in the HAART group (p < 10(-3)). A better immunological outcome was significantly associated with a HIV sexual contamination (p = 0.01), HAART (p = 0.01), high baseline CD4 T-cell count (p < 10(-3)) and low baseline HIV viral load (p = 0.01). In the HAART group, the incidence rate of antiretroviral modification due to tolerance difficulties was 0.23+/-0.36/patient year. A sustained undetectable HIV viral load was correlated with a low baseline HIV viral load (p = 0.003) and to be antiretroviral naive (p < 10(-3)). Thus, HAART provide a better immunological outcome in patients with high CD4 T-cell count. However, the CD4 decay slope after 3 years, the risk of therapeutic side-effects and the low risk of clinical progression do not support systematic treatment of those patients.
Mots clés
Adult, Antiretroviral Therapy, Highly Active, CD4 Lymphocyte Count, methods, Cohort Studies, Female, Follow-Up Studies, HIV Infections, blood, HIV-1, isolation & purification, Humans, Male, Viral Load
Référence
Eur. J. Epidemiol.. 2004 ;19(6):597-604