Risk, predictors, and mortality associated with non-AIDS events in newly diagnosed HIV-infected patients: role of antiretroviral therapy

Published: September 26, 2012

Abstract

Objective: We aimed to characterize non-AIDS events (NAEs) occurring in newly diagnosed HIV-infected patients in a contemporary cohort.

Methods: CoRIS is a prospective, multicentre cohort of HIV-infected patients antiretroviral naive at entry, established in 2004. We evaluated the incidence of- and the mortality due to NAEs and AIDS events through October-2010. Poisson regression was used to investigate factors associated with a higher incidence of NAEs.

Results: Overall, 5,185 patients (13.306 person-years of follow-up), median age (interquartile range) 36 (29-43) years, participated in the study. 86.5% patients had been diagnosed in 2004 or later. The incidence rate (IR) of NAEs was 28.93 per 1000 person-years (95% confidence interval [CI], 26.15-32.07), and of AIDS-defining events 25.23 per 1000 person-years (95% CI, 22.60-28.16). The most common NAEs were psychiatric, hepatic, malignant, renal, and cardiovascular-related. After adjustment, age, higher HIV-viral load and lower CD4 count at cohort entry were associated with the occurrence of NAEs, while likelihood significantly decreased with sexual transmission and higher educational level. Additionally, antiretroviral therapy was inversely associated with the development of some NAEs, specifically of psychiatric (IR ratio [95%CI] 0.54 [0.30-0.96]) and renal-related (IR ratio [95%CI] 0.31 [0.13-0.72]) events. 173 (3.33%) patients died during the study period. NAEs contributed to 28.9% of all deaths, with an IR (95%CI) of 3.75 (2.84-4.94) per 1000-person-years.

Conclusion: In patients newly diagnosed of HIV infection, NAEs are a significant cause of morbidity and mortality. Our results suggest a protective effect of antiretroviral therapy in the occurrence of NAEs, in particular of psychiatric and renal-related events.

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