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1 January 2006

Volume 42, Number 1
Clinical Infectious Diseases 2006;42:136–144
© 2005 by the Infectious Diseases Society of America. All rights reserved.
1058-4838/2006/4201-0022$15.00
DOI: 10.1086/498515
HIV/AIDS MAJOR ARTICLE

Virological Control during the First 6–18 Months after Initiating Highly Active Antiretroviral Therapy as a Predictor for Outcome in HIV‐Infected Patients: A Danish, Population‐Based, 6‐Year Follow‐Up Study

Nicolai Lohse,1,2

Gitte Kronborg,3

Jan Gerstoft,4

Carsten Schade Larsen,5

Gitte Pedersen,7

Court Pedersen,1,2

Henrik Toft Sørensen,6,8 and

Niels Obel1,2

1Department of Infectious Diseases, Odense University Hospital, and 2University of Southern Denmark, Odense, 3Department of Infectious Diseases, Hvidovre University Hospital, Hvidovre, 4Department of Infectious Diseases, Rigshospitalet, Copenhagen, 5Department of Infectious Diseases, Skejby University Hospital, and 6Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, 7Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark; and 8Department of Epidemiology, Boston University, Boston, Massachusetts

Background.Our objective was to examine whether virological control during the first 6–18 months after HAART initiation is a predictor for viral suppression, CD4+ cell count increase, and mortality in human immunodeficiency virus (HIV)–infected patients 18–90 months after initiation of highly active antiretroviral therapy (HAART).

Methods.We conducted a population‐based observational cohort study in Denmark. Patients were divided into 3 groups, according to the proportion of time each patient had a detectable HIV RNA load (i.e., 400 copies/mL) during the 6–18 months after HAART initiation: 0% of the time interval (group 1), 1%–99% of the time interval (group 2), and 100% of the time interval (group 3). The proportion of patients with undetectable HIV RNA, CD4+ cell count changes, and mortality were examined by logistic, linear, and Cox regression analyses, respectively. We constructed cumulative mortality curves.

Results.We observed 2046 patients, for a total of 8898 person‐years of follow‐up that started at 18 months after HAART initiation. Mean CD4+ cell count increase rates during 72 months of follow‐up were as follows: group 1, cells/L per month (95% confidence interval [CI], cells/L); group 2, (95% CI, 2.5–3.3 × 106 cells/L); and group 3, (95% CI, 2.0–3.3 × 106 cells/L). Survival at 72 months were as follows: group 1, 92.7% (95% CI, 90.5%–94.4%); group 2, 85.6% (95% CI, 82.1%–88.5%); and group 3, 76.1% (95% CI, 70.6%–80.7%). At 72 months, 96% of group 1, 83% of group 2, and 57% of group 3 had an HIV RNA load of <400 copies/mL ( ). Treatment interruption before baseline was a predictor of mortality in group 2 (adjusted rate ratio, 2.94; 95% CI, 1.75–4.92]).

Conclusions.Viral suppression during the first 6–18 months after HAART initiation predicts viral suppression, CD4+ cell count progression, and survival at 72 months.

Received 8 June 2005; accepted 29 August 2005; electronically published 30 November 2005.

Reprints or correspondence: Dr. Nicolai Lohse, Dept. of Infectious Diseases, Odense University Hospital, Sdr. Blvd. 29, DK‐5000 Odense C, Denmark ().

Cited by

N. Obel, F. N Engsig, L. D Rasmussen, M. V Larsen, L. H Omland, H. T Sorensen. (2008) Cohort Profile: The Danish HIV Cohort Study. International Journal of Epidemiology
Online publication date: 17-Oct-2008.
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