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Antiretroviral Treatment Lowers Risk of Non-AIDS Illness in People Newly Diagnosed with HIV

Non-AIDS conditions are a significant cause of illness and death for people recently diagnosed with HIV, but starting antiretroviral therapy (ART) can reduce the likelihood of non-AIDS events including psychiatric and kidney problems, according to study findings published in the September 26, 2012, advance online edition of AIDS.

As incidence of AIDS-defining conditions such as Kaposi sarcoma and PCP pneumonia have fallen dramatically since the widespread adoption of combination antiretroviral treatment, non-AIDS illnesses are now responsible for more morbidity and mortality among people with HIV.

Mar Masiá from Hospital General Universitario de Elche in Spain and colleagues conducted a study to characterize non-AIDS events occurring among newly diagnosed HIV patients.

The prospective CoRIS cohort, established in 2004, includes HIV positive people at multiple centers in Spain who were treatment-naive at study entry. The researchers looked at incidence of, and mortality due to, non-AIDS and AIDS events occurring through October 2010.

The analysis included 5185 HIV positive participants. About 80% were men and the median age was 36 years. Most (87%) were diagnosed with HIV in 2004 or later. About two-thirds (68%) started ART; the mean CD4 T-cell count at the start of treatment rose from about 150 cells/mm³ during the first half of the study to nearly 300 cells/mm³ during the second half. The median follow-up period was about 2 years and participants collectively contributed a total of 13,306 person-years of follow-up data.

Results

• A total of 423 non-AIDS events occurred during follow-up.
• A total of 318 AIDS-defining events occurred, most (88%) within 3 months of HIV diagnosis.
• 173 participants (3%) died during the study period, 29% of them due to non-AIDS illnesses.
• The overall incidence rate of non-AIDS events was approximately 29 per 1000 person-years.
• The overall incidence rate of AIDS-defining events was similar, approximately 25 per 1000 person-years.
• Non-AIDS events were a contributing factor in 29% of all deaths, with an incidence rate of approximately 4 per 1000 person-years.
• The incidence of non-AIDS events decreased over time, falling from 35 per 1000 person-years during 2004-2007 to 25 cases per 1000 person-years during 2007-2010.
• The most common non-AIDS events were:

o   Psychiatric problems, especially depression: 122 events;

o   Liver disease: 57 events;

o   Cancers, especially lung cancer, non-Hogkin lymphoma, head/neck cancers, liver cancer, and anal cancer: 54 events;

o   Kidney problems: 42 events;

o   Cardiovascular conditions: 34 events.

• After adjusting for age, detectable HIV viral load and lower CD4 cell count at entry into the cohort were associated with higher risk of non-AIDS events.
• Acquiring HIV through sexual transmission (e.g., as opposed to injection drug use) and higher educational level were associated with lower risk for non-AIDS events.
• Use of ART was associated with lower likelihood of developing of some non-AIDS events:

o   Psychiatric illness: incidence rate ratio 0.54, or about half the risk;

o   Kidney-related conditions: incidence rate ratio 0.31, or about one-third the risk.

"In patients newly diagnosed of HIV infection, non-AIDS events are a significant cause of morbidity and mortality," the study investigators concluded. "Our results suggest a protective effect of antiretroviral therapy in the occurrence of non-AIDS events, in particular of psychiatric and renal-related events."

"Clinicians should be aware that during the initial follow-up after HIV diagnosis non-AIDS events do occur," they elaborated in their discussion. "Older patients and those presenting with lower CD4 cell counts and higher viral load are at increased risk of their occurrence."

They added that smoking cessation and screening and management of hepatitis C coinfection (cause of liver cancer) and human papillomavirus (cause of anal, genital, and some head/neck cancers) could help reduce mortality in this population.

11/6/12

Reference

M Masiá, S Padilla, D Álvarez, Débora, et al (CoRIS). Risk, predictors, and mortality associated with non-AIDS events in newly diagnosed HIV-infected patients: role of antiretroviral therapy. AIDS. September 26, 2012 (Epub ahead of print).