Predictive role of the three-month CD4 cell count in the long-term clinical outcome of the first HAART regimen

The aim was to evaluate whether the three-month CD4 cell counts are a relia ble predictor of the long-term clinical outcome of HAART-treated patients, by an observational study of 585 patients initiating HAART in a clinical se tting. Clinical failure was defined as the occurrence of new or recurrent A IDS-defining events or death, and was analysed by means of intention-to-tre at, univariate and multivariate analyses. An adjusted Cox regression model was used to evaluate the effect of three-month CD4+ counts on clinical outc ome. Clinical failure occurred in 65 patients (11.1%) during a median follo w-up of 31 months (1-65) as a result of new AIDS-defining events (ADEs) in 48 patients, ADE recurrence in six, and death in 11. The mean (median; rang e) CD4+ counts were 156/ul (155; 4-529) in patients with and 362/muL (326; 18-1162) in patients without clinical failure (P < .0001). Moreover, the pr oportion of patients with mean CD4+ counts < 200 muL was higher in those ex periencing subsequent clinical failure (chi (2): 41.11; P < .00001). Multiv ariate analysis showed that baseline CD4+ counts < 50 muL, HIV-RNA > 100,00 0 copies/mL and AIDS at baseline predicted failure; after adjusting for thr ee-month CD4+ counts, this marker was the only one independently associated with clinical failure (HR 2.93; 95% CI: 1.16-7.38). The three-month immuno logic response is a reliable predictor of long-term clinical outcome. (C) 2 001 Editions scientifiques et medicales Elsevier SAS.