Abstract
BackgroundDiagnosis of primary HIV infection (PHI) has important clinical and public health implications. HAART initiation at this stage remains controversial.MethodsOur objective was to identify predictors of disease progression among Argentinean seroconverters during the first year of infection, within a multicentre registry of PHI-patients diagnosed between 1997 and 2008. Cox regression was used to analyze predictors of progression (LT-CD4 < 350 cells/mm3, B, C events or death) at 12 months among untreated patients.ResultsAmong 134 subjects, 74% presented with acute retroviral syndrome (ARS). Seven opportunistic infections (one death), nine B events, and 10 non-AIDS defining serious events were observed. Among the 92 untreated patients, 24 (26%) progressed at 12 months versus three (7%) in the treated group (p = 0.01). The 12-month progression rate among untreated patients with ARS was 34% (95% CI 22.5-46.3) versus 13% (95% CI 1.1-24.7) in asymptomatic patients (p = 0.04). In univariate analysis, ARS, baseline LT-CD4 < 350 cells/mm3, and baseline and six-month viral load (VL) > 100,000 copies/mL were associated with progression. In multivariate analysis, only ARS and baseline VL > 100,000 copies/mL remained independently associated; HR: 8.44 (95% CI 0.97-73.42) and 9.44 (95% CI 1.38-64.68), respectively.ConclusionsIn Argentina, PHI is associated with significant morbidity. HAART should be considered in PHI patients with ARS and high baseline VL to prevent disease progression.
Highlights
Diagnosis of primary HIV infection (PHI) has important clinical and public health implications
This paper describes the epidemiological, clinical, immunological and virological characteristics of the first 134 patients enrolled in our cohort with the aim of identifying potential markers associated with HIV progression
The date of infection was Baseline characteristics As of December 2008, 134 patients with primary HIV infection were enrolled in the cohort; 99 retrospectively and 35 prospectively
Summary
Diagnosis of primary HIV infection (PHI) has important clinical and public health implications. Cohort studies addressing primary HIV infection (PHI) have been used as a tool to study the natural history of HIV and to estimate the incidence of AIDS-defining events, as well as other non-associated AIDS comorbidities. Scarce information exists on this issue from resourcelimited settings, in South America, where there are different host, social and viral (i.e., subtype) characteristics that may alter the course of HIV infection [6,7,8]. Information regarding patients diagnosed during the early stages of infection is limited. To address this situation, a multicentre registry of patients with primary HIV infection in Argentina was started in 2008 [10,11]
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