Impacto de la inmunodepresión basal y su grado de recuperación al año de terapia antirretroviral en sobrevida, complicaciones oportunistas y reacción de recuperación inmune

Background: Baseline (BL) CD4 cell count is a major factor in outcome of highly active antiretroviral therapy (HAART); treatment induced immune recovery and viral response can modulate this outcome. Aim: To evaluate the association between baseline CD4 cell count and outcome during the first HAART régimen. Material and methods: Prospective study in 2,050 patients on first HAART with a follow up (f/u) ofat least 1 year. All had BL CD4 and viral load (VL) counts which were repeated at least twice a year. Patients were grouped according to BL CD4 (cells/mm³) in &lt;100 (Gl), 100-199 (G2) and &#8805; (G3). Groups were further divided according to immune and vírologícal response at 1 year in CD4 > or &lt; 200 and VL detectable or undetectable (&lt;80 copies/mL). Outcome measures were death, ALUS defining events (ADE) and, as a surrogate marker of immune recovery reaction, herpes zoster (HZ). Resulte: During the first year of follow up, 113 patients (10.8%) diedin Gl (n =1,044), 17 (2.5%) in G2 (n =675) (Gl-2 p <0.05) and 9 (2.7%) in G3 (n =331) (G2-3 p NS). One hundred twenty five of919 (13.6%) patients alive at 1 year had ADE in Gl, 55/643 (8.5%) in G2 (p <0.05) and 20/320 (5.2%) in G3 (G2-3 p NS). ADEs with follow up CD4 >vs&lt; 200 were: 25/274 (9.1%) vs 100/643 (15 7%) in Gl (p <0.005); 28/404 (6.9%) vs 27/235 (11.2%) in G2 (p NS) and 18/281 (6.4%) vs 2/41 (4.8%) in G3 respectively (p NS). Detectable VL was an additional risk for ADE only in Gl without CD4 recovery. HZ was seen in 6.6% of Gl vs 4% in G2 (p <0.05) and 4.3% in G3. HZ rate was higher in all groups reaching a follow up CD4 >200 than those who did not, with a statistically significant difference at p <0.05 only in Gl (9.5% vs 5.3%). Conclusions: The occurrence of death and ADE during the first year of HAART was significantly higher in patients with aBL CD4 <100, but no statistically significant difference was observed from BL CD4 >100 upwards. Immune recovery during f/u in the more immunosuppressed group greatly improved the outcome. The group with lowest BL CD4 and greater immune recovery showed the highest rate of immune recovery reaction.

Bibliographic Details

Main Authors:	Cortés,Claudia, Beltrán,Carlos, Muñoz,Rodrigo, Daube,Elizabeth, Wolff,Marcelo
Format:	Digital revista
Language:	Spanish / Castilian
Published:	Sociedad Médica de Santiago 2008
Online Access:	http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872008001200001
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