Risk factors related to infections during the first year of highly active antiretroviral therapy

BACKGROUND: To evaluate the immunological, virological and clinical respons e of HIV -infected patients who start combined therapy with protease inhibi tors (PI) in a community hospital. To identify risk factors related with in fections. PATIENTS AND METHOD: Clinical review of patients with combined therapy, ass essing CD4(+) cell counts, viral load (Amplicor) and development of infecti ons during the first year on PI (group A) and comparative study with the sa me patients during the previous year with PI (group B). RESULTS: 134 patients were included in group A and 84 in group B. Nadir of CD4(+) was 169 x 10(6)/l. After 6 months of PI therapy, the mean CD4 increa sed from 217 to 355 x 10(6)/l and the median viral load decreased from 88,0 00 copies/ml (14,000-485,000) to less than 400 copies /ml (< 400-9,000), 60 % of patients had less than 400 copies/ml. The incidence of non-oportunisti c infections was similar in both groups (36 vs 43%; p = NS). However, the r ate of opportunistic infections decreased from 30 to 15% (RR: 0.41 [CI 0.21 -0.81]; p = 0.007) in the group with PI, particulary Pneumocytis carinii pn eumonia and toxoplasmosis, Multivariated analysis including CD4(+) cell cou nt, nadir of CD4(+), viral load and risk behavior only nadir of CD4 > 100 x 10(6)/l was associated with a lower risk of developing opportunistic infec tions (RR: 0.2 [CI, 0.1-0.7]; p=0.001). CONCLUSIONS: Combined therapy with Pi improved immunological and virologica l markers and decreased the rate of opportunistic infections. A CD4) cell c ount nadir higher than 100 x 10(6)/l was a marker of good prognosis during the first year with PI irrespective of response to therapy.