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Symptomatic Illness and Low CD4 Cell Count at HIV Seroconversion as Markers of Severe Primary HIV Infection

BACKGROUND: The risk/benefit of initiating ART in primary HIV infection (PHI) is unclear. The benefits are more likely to outweigh the risks in patients with severe PHI. An accepted definition of severe PHI is, however, lacking. METHODS: CASCADE patients with HIV test interval <6 months were clas...

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Autores principales: Lodi, Sara, Fisher, Martin, Phillips, Andrew, De Luca, Andrea, Ghosn, Jade, Malyuta, Ruslan, Zangerle, Robert, Moreno, Santiago, Vanhems, Philippe, Boufassa, Faroudy, Guiguet, Marguerite, Porter, Kholoud
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3828389/
https://www.ncbi.nlm.nih.gov/pubmed/24244330
http://dx.doi.org/10.1371/journal.pone.0078642
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author Lodi, Sara
Fisher, Martin
Phillips, Andrew
De Luca, Andrea
Ghosn, Jade
Malyuta, Ruslan
Zangerle, Robert
Moreno, Santiago
Vanhems, Philippe
Boufassa, Faroudy
Guiguet, Marguerite
Porter, Kholoud
author_facet Lodi, Sara
Fisher, Martin
Phillips, Andrew
De Luca, Andrea
Ghosn, Jade
Malyuta, Ruslan
Zangerle, Robert
Moreno, Santiago
Vanhems, Philippe
Boufassa, Faroudy
Guiguet, Marguerite
Porter, Kholoud
author_sort Lodi, Sara
collection PubMed
description BACKGROUND: The risk/benefit of initiating ART in primary HIV infection (PHI) is unclear. The benefits are more likely to outweigh the risks in patients with severe PHI. An accepted definition of severe PHI is, however, lacking. METHODS: CASCADE patients with HIV test interval <6 months were classified as severe and non-severe PHI based on whether the following traits were recorded in the first 6 months following seroconversion: severe specific pre-defined symptoms, central nervous system-implicated illness, and ≥1, ≥2 CD4<350 (and <500) cells/mm(3). For each definition, we used Kaplan-Meier curves and Cox survival models to compare time to AIDS/death, censoring at the earlier of last clinic visit or 1/1/1997, when combination antiretroviral therapy (cART) became available. RESULTS: Among 1108 included patients mostly males (85%) infected through sex between men (71%), 366 were diagnosed with AIDS/died. The risk of AIDS/death was significantly higher for individuals with severe symptoms, those with ≥1 CD4<350 cells/mm(3) or ≥2 CD4 <500 cells/mm(3) in the first 6 months [aHR (95% confidence interval) 2.1 (1.4,3.2), 2.0 (1.5,2.7), and 2.3, (1.5–3.5) respectively]. Median [interquantile range] survival for patients with ≥2, ≥1 and no CD4<350 cells/mm(3) within 6 months of seroconversion was 3.9 [2.7,6.5], 5.4 [4.5,8.4] and 8.1 [4.3,10.3] years, respectively. The diagnosis of CNS-implicated symptoms was rare and did not appear to be prognostic. CONCLUSION: One CD4 count <350 or two <500 cells/mm(3) within 6 months of seroconversion and/or severe illness in PHI may be useful early indicators of individuals at high risk of disease progression.
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spelling pubmed-38283892013-11-16 Symptomatic Illness and Low CD4 Cell Count at HIV Seroconversion as Markers of Severe Primary HIV Infection Lodi, Sara Fisher, Martin Phillips, Andrew De Luca, Andrea Ghosn, Jade Malyuta, Ruslan Zangerle, Robert Moreno, Santiago Vanhems, Philippe Boufassa, Faroudy Guiguet, Marguerite Porter, Kholoud PLoS One Research Article BACKGROUND: The risk/benefit of initiating ART in primary HIV infection (PHI) is unclear. The benefits are more likely to outweigh the risks in patients with severe PHI. An accepted definition of severe PHI is, however, lacking. METHODS: CASCADE patients with HIV test interval <6 months were classified as severe and non-severe PHI based on whether the following traits were recorded in the first 6 months following seroconversion: severe specific pre-defined symptoms, central nervous system-implicated illness, and ≥1, ≥2 CD4<350 (and <500) cells/mm(3). For each definition, we used Kaplan-Meier curves and Cox survival models to compare time to AIDS/death, censoring at the earlier of last clinic visit or 1/1/1997, when combination antiretroviral therapy (cART) became available. RESULTS: Among 1108 included patients mostly males (85%) infected through sex between men (71%), 366 were diagnosed with AIDS/died. The risk of AIDS/death was significantly higher for individuals with severe symptoms, those with ≥1 CD4<350 cells/mm(3) or ≥2 CD4 <500 cells/mm(3) in the first 6 months [aHR (95% confidence interval) 2.1 (1.4,3.2), 2.0 (1.5,2.7), and 2.3, (1.5–3.5) respectively]. Median [interquantile range] survival for patients with ≥2, ≥1 and no CD4<350 cells/mm(3) within 6 months of seroconversion was 3.9 [2.7,6.5], 5.4 [4.5,8.4] and 8.1 [4.3,10.3] years, respectively. The diagnosis of CNS-implicated symptoms was rare and did not appear to be prognostic. CONCLUSION: One CD4 count <350 or two <500 cells/mm(3) within 6 months of seroconversion and/or severe illness in PHI may be useful early indicators of individuals at high risk of disease progression. Public Library of Science 2013-11-14 /pmc/articles/PMC3828389/ /pubmed/24244330 http://dx.doi.org/10.1371/journal.pone.0078642 Text en © 2013 Lodi et al http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.
spellingShingle Research Article
Lodi, Sara
Fisher, Martin
Phillips, Andrew
De Luca, Andrea
Ghosn, Jade
Malyuta, Ruslan
Zangerle, Robert
Moreno, Santiago
Vanhems, Philippe
Boufassa, Faroudy
Guiguet, Marguerite
Porter, Kholoud
Symptomatic Illness and Low CD4 Cell Count at HIV Seroconversion as Markers of Severe Primary HIV Infection
title Symptomatic Illness and Low CD4 Cell Count at HIV Seroconversion as Markers of Severe Primary HIV Infection
title_full Symptomatic Illness and Low CD4 Cell Count at HIV Seroconversion as Markers of Severe Primary HIV Infection
title_fullStr Symptomatic Illness and Low CD4 Cell Count at HIV Seroconversion as Markers of Severe Primary HIV Infection
title_full_unstemmed Symptomatic Illness and Low CD4 Cell Count at HIV Seroconversion as Markers of Severe Primary HIV Infection
title_short Symptomatic Illness and Low CD4 Cell Count at HIV Seroconversion as Markers of Severe Primary HIV Infection
title_sort symptomatic illness and low cd4 cell count at hiv seroconversion as markers of severe primary hiv infection
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3828389/
https://www.ncbi.nlm.nih.gov/pubmed/24244330
http://dx.doi.org/10.1371/journal.pone.0078642
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