SURVIVAL AFTER AIDS-DEFINING EVENTS IN PATIENTS WITH LESS-THAN-200 LYMPHOCYTES CD4+X10(6) L WHO ARE TOXOPLASMOSIS ANTIBODY-POSITIVE/

The objective of this study was to assess whether patients with CD4+ c ell counts <200 x 10(6)/L have a decreased survival after the occurren ce of any AIDS-defining event; 187 patients from the placebo arm of a clinical trial of toxoplasmosis prophylaxis (ANRS005-ACTG154) were inc luded. For this analysis, patients were HIV infected without any AIDS- defining event, had a CD4+ lymphocyte count <200 x 10(6)/L, had a posi tive serology for Toxoplasma gondii, and had no severe liver, renal, o r hematologic abnormalities. We used proportional hazards regression t o study the relationships between baseline variables. AIDS-defining ev ents as time-dependent variables, and survival. The risk of dying was increased by 1.9 for a 10-year increase in age and by 1.3 when CD4(+) decreased by 50 x 10(6)/L; after the occurrence of a pneumocystosis, a cytomegalovirus infection, or a toxoplasmosis, the risk of dying was multiplied, respectively, by 10.9 (3.0-40.2), 10.0 (2.8-35.4), and 10. 0 (4.5-22.2). None of the other AIDS-defining events was associated wi th an increased risk of dying, but the power to detect such an associa tion was limited. We conclude that the occurrence of pneumocystosis, c ytomegalovirus infection, or toxoplasmosis; age; and CD4+ cell count a re important determinants of survival for HIV1-infected patients with CD4+ counts <200 X 10(6)/L who are toxoplasmosis antibody positive.