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Factors Associated with the Development of Opportunistic Infections in HIV-1-Infected Adults with High CD4+ Cell Counts: A EuroSIDA Study

Podlekareva, Daria ; Mocroft, Amanda ; Dragsted, Ulrik B. ; Ledergerber, Bruno ; Beniowski, Marek ; Lazzarin, Adriano ; Weber, Jonathan ; Clumeck, Nathan ; Vetter, Norbert ; Phillips, Andrew

In: The Journal of Infectious Diseases, 2006, vol. 194, no. 5, p. 633-641

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    Titre
    • Factors Associated with the Development of Opportunistic Infections in HIV-1-Infected Adults with High CD4+ Cell Counts: A EuroSIDA Study
    Auteur
    • Podlekareva, Daria. Hvidovre University Hospital, Hvidovre, Denmark
    • Mocroft, Amanda. Royal Free Hospital and University College London Medical School and
    • Dragsted, Ulrik B.. Hvidovre University Hospital, Hvidovre, Denmark
    • Ledergerber, Bruno. University Hospital Zürich, Zürich, Switzerland
    • Beniowski, Marek. Medical University of Silesia, Chorzow, Poland
    • Lazzarin, Adriano. San Raffaele Scientific Institute, Milan, Italy
    • Weber, Jonathan. St. Mary's Hospital, London, United Kingdom
    • Clumeck, Nathan. Saint-Pierre Hospital, Brussels, Belgium
    • Vetter, Norbert. Pulmonary Center of the City of Vienna, Vienna, Austria
    • Phillips, Andrew. Royal Free Hospital and University College London Medical School and
    Type de document
    • Postprint
    Langue
    • Inglese
    Publié dans
    • The Journal of Infectious Diseases, 2006, vol. 194, no. 5, p. 633-641. The University of Chicago Press
    Autre version électronique
    Classification
    • Santé
    Identifiant OAI-PMH
    • oai:doc.rero.ch:293936
    Summary
    BackgroundLimited data exist on factors predicting the development of opportunistic infections (OIs) at higher-than-expected CD4+ cell counts in human immunodeficiency virus (HIV) type 1-infected adults MethodsMultivariate Poisson regression models were used to determine factors related to the development of groups of OIs above their respective traditional upper CD4+ cell count thresholds: group 1 (⩾100 cells/μL), OIs caused by cytomegalovirus, Mycobacterium avium complex, and Toxoplasma gondii; group 2 (⩾200 cells/μL), Pneumocystis pneumonia and esophageal candidiasis; and group 3 (⩾300 cells/μL), pulmonary and extrapulmonary tuberculosis ResultsIn groups 1, 2, and 3, 71 of 9219, 125 of 7934, and 36 of 7838 patients, respectively, developed ⩾1 intragroup OI. The strongest predictor of an OI in groups 1 and 2 was current CD4+ cell count (for group 1, incidence rate ratio [IRR] per 50% lower CD4+ cell count, 5.37 [95% confidence interval {CI}, 3.71-7.77]; for group 2, 4.28 [95% CI, 2.98-6.14]). Injection drug use but not current CD4+ cell count predicted risk in group 3. Use of antiretroviral treatment was associated with a lower incidence of OIs in all groups, likely by reducing HIV-1 RNA levels (IRR per 1-log10 copies/mL higher HIV-1 RNA levels for group 1, 1.50 [95% CI, 1.15-1.95]; for group 2, 1.68 [95% CI, 1.40-2.02]; and for group 3, 1.89 [95% CI, 1.40-2.54]) ConclusionAlthough the absolute incidence is low, the current CD4+ cell count and HIV-1 RNA level are strong predictors of most OIs in patients with high CD4+ cell counts