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Response to HAART in naïve patients with a diagnosis of tuberculosis
Presented by Santiago Moreno, Spain.
S. Moreno1, P. Sobrino2, A.M. Caro Murillo2, J.A. Iribarren3, J.M. Ramos4, F. Vidal5, G. Navarro6, J. López Aldeguer7, I. Santos8, J. del Amo2, CoRIS
1Hospital Ramón y Cajal, Infectious Diseases, Madrid, Spain, 2Centro Nacional de Epidemiología, CoRIS, Madrid, Spain, 3Hospital Donostia, Infectious Diseases, San Sebastián, Spain, 4Hospital de Elche, Infectious Diseases, Elche, Spain, 5Hospital Joan XXIII, Infectious Diseases, Tarragona, Spain, 6Hospital Parc Tauli, Infectious Diseases, Sabadell, Spain, 7Hospital La Fe, Infectious Diseases, Valencia, Spain, 8Hospital de la Princesa, Infectious Diseases, Madrid, Spain
Background: Our objective is to evaluate immunological, virological and clinical responses to HAART, and all-cause mortality in naïve patients with a diagnosis of tuberculosis (TB), subjects with another AIDS event (AI) or event-free individuals.
Methods: Open multicenter hospital-based cohort of HIV-infected naïve adults from 19 Spanish hospitals since 2004. Censoring date was November 2006. Patients were classified as having had a TB diagnosis, other AIDS-defining illness (ADI), or being event-free previous to commencing HAART. Immunological response was defined as an increase of 50 and/or 100 cells/ml six months after HAART; virological response as percentage reaching viral load (VL) below 200 copies six months after HAART. Clinical response was defined as the number of new ADI after HAART. All cause mortality rates were calculated and modelled with multivariate Cox regression adjusting for age, sex, transmission category and CD4 count at starting HAART.
Results: Of 2564 patients, 1481 (58%) started HAART; among these 80 had had previous TB and 254 another ADI. Median time from TB diagnosis to HAART inititation was 67 days, and for other ADI was 23 days. Overall, 5% developed a new ADI during follow-up; 80% reached VL suppression and 81%/64% had increases of 50/100 cells, respectively. No statistically significant differences were found according to previous history of TB or another ADI. In all, 37 subjects died in 1521 person-years with a mortality rate of 2.4 (95%CI:1.7-3.3). When compared to subjects who started HAART without a previous ADI (HR:1.00), both a previous diagnosis of TB (HR 2.89 95%CI:0,92-9.04) and of another ADI (HR 2.53 95%CI:1.36-4.71) were associated with an increased risk of death.
Conclusions: A previous diagnosis of TB or another ADI before HAART does not compromise short-term viral and immunological response to treatment but it is associated with more than a two-fold increase in all cause mortality.
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