Acute retroviral syndrome and high baseline viral load are predictors of rapid HIV progression among untreated patients diagnosed during primary HIV infection in Argentina
Presented by María Eugenia Socías (Argentina).
M.E. Socías1,2, O. Sued2, N. Laufer1,3, H. Mingrone4, C. Acuipil4, E. Loiza4, L. Amante5, C. Remondegui5, M. Lázaro6, D. Pryluka7, M. Cabrini1, M.I. Figueroa1, G. Turk8, A. Gun2, M.B. Bouzas4, M.C. Iannella9, H. Salomón8, A. Krolewiecki2, H. Pérez1, P. Cahn1,2, Grupo Argentino de Seroconversión
1Hospital Juan A. Fernández, Infectious Diseases Unit, Buenos Aires, Argentina, 2Fundación Huésped, Buenos Aires, Argentina, 3Nexo Asociación Civil, Buenos Aires, Argentina, 4Hospital Muñiz, Buenos Aires, Argentina, 5Hospital San Roque, San Salvador de Jujuy, Argentina, 6Hospital Zonal Ramón Carrillo, Bariloche, Argentina, 7MEDICUS, Buenos Aires, Argentina, 8Centro Nacional de Referencia para el SIDA, Buenos Aires, Argentina, 9Universidad de Buenos Aires, Facultad de Ciencias Económicas, Math Department, Buenos Aires, Argentina
Background: Diagnosis of Primary HIV Infection (PHI) is challenging and has important clinical and public health implications. PHI treatment is controversial.
Objective: To describe clinical and immunological outcomes and identify potential predictors of progression during the first year of infection among Argentinean seroconverters.
Methods: Multicenter registry of PHI-patients (negative/indeterminate WB + positive virologic test or positive WB with negative HIV-test within the previous 6 months). Cox regression was used to analyze potential predictors of progression (LT-CD4< 350 cells/µL, B or C events) at 12 months among untreated PHI-patients diagnosed between 1997-2008. Time until event was studied with Kaplan-Meier survival analysis.
Results: n=134 (males=109), 53% MSM, 37% heterosexuals. At baseline: median age 32 (IQR 25-39), median VL: 74,275 copies/mL (IQR 12,738-326,005), median LT-CD4: 479 cells/µL (IQR 341-682). Acute retroviral syndrome (ARS): 74%. Seven OIs (1 death), 9 B events and 10 non-AIDS defining serious events were observed. Forty-two patients started HAART (< 90 days of infection). Among the 92 untreated patients, 24 (26%) progressed at 12 months (1 died) versus 3 (7%) in the treated group (p=0.01). Estimates of rates of progression at 12 months among untreated patients with ARS were 34% (95%CI 22.5-46.3%) versus 13% (95%CI 1.1-24.7%) in asymptomatic patients (p=0.04). In univariate analysis, high baseline and six-month VL and lower baseline LT-CD4 were associated with progression. No association was found with age, gender, mode of HIV acquisition and calendar-year of infection. In multivariate analysis, only ARS (p=0.034) and baseline VL>100,000 copies/mL (p=0.015) remained as independent predictors of progression; HR 9.23 (95%CI 1.2-72.4) and 16.4 (95%CI 1.74-154.6), respectively.
Conclusions: In Argentina, PHI is associated with significant morbidity. One quarter of patients would require HAART during the first year according to current guidelines. HAART should be considered in PHI-patients with ARS and high baseline VL to prevent disease progression.
Partially granted by Fogarty/NIH AITRP Grant#D43TW0010137.
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