Author(s):
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Zhang, S.; Sighem, A. van; Kesselring, A.; Gras, L.; Prins, J.M.; Hassink, E.; Kauffmann, R.; Richter, C.; Wolf, F. de; Reiss, P.;
Koopmans †, P.P.
;
Keuter, M.
;
Ven, A.J.A.M. van der
;
Hofstede, H.J.M. ter
;
Dofferhoff, A.S.M.
;
Warris, A.
;
Crevel, R. van
; et al.
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Subject:
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Radboudumc 4: lnfectious Diseases and Global Health RIHS: Radboud Institute for Health Sciences Radboudumc 4: lnfectious Diseases and Global Health RIMLS: Radboud Institute for Molecular Life Sciences |
Organization:
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Internal Medicine Paediatrics - OUD tm 2017 |
Abstract:
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OBJECTIVES: Certain non-AIDS-related diseases have been associated with immunodeficiency and HIV RNA levels in HIV-infected patients on combination antiretroviral therapy (cART). We aimed to investigate these associations in patients not yet on cART, when potential antiretroviral-drug-related effects are absent and variation in RNA levels is greater. METHODS: Associations between, on the one hand, time-updated CD4 counts and plasma HIV RNA and, on the other hand, a composite non-AIDS-related endpoint, including major cardiovascular diseases, liver fibrosis/cirrhosis, and non-AIDS-related malignancies, were studied with multivariate Poisson regression models in 12 800 patients diagnosed with HIV infection from 1998 onwards while not yet treated with cART. RESULTS: During 18 646 person-years of follow-up, 203 non-AIDS-related events occurred. Compared with a CD4 count >/= 500 cells/muL, adjusted relative risks (RRs) for the composite endpoint were 4.71 [95% confidence interval (CI) 2.98-7.45] for a CD4 count < 200 cells/muL, 2.06 (95% CI 1.38-3.06) for a CD4 count of 200-349 cells/muL, and 1.19 (95% CI 0.82-1.74) for a CD4 count of 350-499 cells/muL. There was no evidence for an independent association with HIV RNA. Other important covariates were age [RR 1.40 (95% CI 1.31-1.49) per 5 years older], hepatitis B virus coinfection [RR 5.66 (95% CI 3.87-8.28)] and hepatitis C virus coinfection [RR 9.26 (95% CI 6.04-14.2)]. CONCLUSIONS: In persons not yet receiving cART, a more severe degree of immunodeficiency rather than higher HIV RNA levels appears to be associated with an increased risk of our composite non-AIDS-related endpoint. Larger studies are needed to address these associations for individual non-AIDS-related events.
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