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Increased risk of non-AIDS-related events in HIV subjects with persistent low CD4 counts despite cART in the CoRIS
Y M Pacheco1, I Jarrin2, I Rosado1
1Laboratory of Immunovirology, Clinic Unit of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville, IBiS, Virgen del Rocío University Hospital/CSIC/University of Seville, Seville 41013, Spain.
Insights
HIV patients with persistently low CD4 counts despite effective combination antiretroviral therapy (cART) face increased risks of death and non-AIDS-defining cancers. Managing accelerated aging is crucial for this vulnerable population.
Area of Science:
- Infectious Diseases
- Immunology
- Oncology
Background:
- Combination antiretroviral therapy (cART) has transformed HIV management.
- Some individuals achieve viral suppression but maintain low CD4+ T-cell counts.
- Clinical outcomes in this specific subgroup require further investigation.
Purpose of the Study:
- To analyze clinical complications in HIV-infected patients with persistent low CD4 counts despite virological response to cART.
- To identify specific risks, including mortality and non-AIDS-defining events, in this cohort.
- To inform strategies for managing long-term complications in HIV.
Main Methods:
- Retrospective analysis of the Spanish CoRIS cohort.
- Inclusion criteria: CD4 <200 cells/mm³ at cART initiation and viral load <500 copies/mL for ≥2 years.
- Classification into 'Low-CD4 group' (<250 cells/mm³ at 2 years post-cART) and Poisson regression for event incidence.
Main Results:
- 287 out of 1128 eligible patients (25.4%) were classified in the Low-CD4 group.
- The Low-CD4 group exhibited a significantly higher risk of death (aIRR: 4.71) and non-AIDS-defining malignancies (non-ADM) (aIRR: 2.23).
- Increased risks for cardiovascular, kidney, and liver events were also assessed.
Conclusions:
- Persistent low CD4 counts post-cART are associated with increased mortality and non-ADM, particularly cancer.
- Accelerated aging and its associated non-AIDS-defining diseases are significant concerns in this population.
- Genetics and lifestyle may influence clinical complications in HIV-infected individuals on cART.
Abstract:
The aim was to analyze clinical complications in HIV-infected subjects who persistently maintain low CD4 levels despite virological response to cART in the Spanish CoRIS cohort. The main inclusion criteria were CD4 counts <200cells/mm(3) at cART-initiation and at least 2years under cART achieving a viral load <500copies/mL. Those patients with CD4 counts <250cells/mm(3) 2years after cART were classified as the Low-CD4 group, and clinical events were collected from this time-point. Poisson regression models were used to calculate incidence rate ratios of death, AIDS-defining events, serious non-AIDS-defining events (NAE) and of each specific NAE category (non-AIDS-defining malignancies (non-ADM), cardiovascular, kidney- and liver-related events). Of 9667 patients in the cohort, a total of 1128 met the criteria and 287 (25.4%) were classified in the Low-CD4 group. A higher risk of death (aIRR: 4.71; 95% CI: 1.88-11.82; p-value=0.001) and of non-ADM were observed in this group (aIRR: 2.23; 95% CI: 1.07-4.63; p=0.03). Our results stress the need to control accelerated aging in this population to counter their increased risk of non-AIDS-defining diseases, particularly cancer, and are consistent with the concept that clinical complications are potentially affected by genetics and lifestyle.
