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Título: | Rate and predictors of progression in elite and viremic HIV-1 controllers |
Autor: | Leon, Agathe; Pérez, Ignacio CSIC; Ruiz-Mateos, Ezequiel CSIC ORCID; Benito, José Miguel; Leal, Manuel CSIC; López-Galíndez, Cecilio; Rallón, Norma; Alcamí, José CSIC ORCID; López-Aldeguer, José; Viciana, Pompeyo CSIC; Rodríguez, Carmen CSIC ORCID ; Grau, Eulalia; Iribarren, José A.; Gatell, José María; García, Felipe | Palabras clave: | Controllers HIV-1 progression Predictive models |
Fecha de publicación: | 15-may-2016 | Editor: | Lippincott Williams & Wilkins | Citación: | AIDS 30(8): 1209-1220 (2016) | Resumen: | [Background] The proportion of HIV controllers developing virologic, immunological or clinical progression and the baseline predictors of these outcomes have not been assessed in large cohorts.
[Methods] A multicenter cohort of HIV controllers was followed from baseline (the first of the three HIV-1 RNA levels < 50 in elite controller or from 50 to 2000 copies/ml in viremic controllers) up to August 2011, to the development of a progression event (loss of viral load control, CD4+ decline, AIDS or death) or to the censoring date (lost to follow-up or initiation of antiretroviral therapy). Predictive models of progression at baseline and a risk score for the combined HIV-1 progression end point were calculated. [Results] Four hundred and seventy-five HIV-1 controllers of whom 204 (42.9%) were elite controller with 2972 person-years of follow-up were identified. One hundred and forty-one (29.7%) patients lost viral load control. CD4+ cell count declined in 229 (48.2%) patients. Thirteen patients developed an AIDS event and four died. Two hundred and eighty-seven (60.4%) developed a combined HIV-1 progression. Baseline predictors for the progression end points and for elite and viremic controller patients were very similar: risk for HIV-1 acquisition, baseline calendar year, CD4+ nadir, viral load before baseline and hepatitis C virus coinfection. The probability of a combined HIV-1 progression at 5 years was 70% for elite controllers with the highest score compared with 13% for those with the lowest. [Methods] A multicenter cohort of HIV controllers was followed from baseline (the first of the three HIV-1 RNA levels < 50 in elite controller or from 50 to 2000 copies/ml in viremic controllers) up to August 2011, to the development of a progression event (loss of viral load control, CD4+ decline, AIDS or death) or to the censoring date (lost to follow-up or initiation of antiretroviral therapy). Predictive models of progression at baseline and a risk score for the combined HIV-1 progression end point were calculated. [Conclusion] HIV-1 disease progression in elite and viremic controllers is frequent. We propose a baseline clinical score to easily classify these patients according to risk of progression. This score could be instrumental for taking clinical decisions and performing pathogenic studies. |
Versión del editor: | https://doi.org/10.1097/QAD.0000000000001050 | URI: | http://hdl.handle.net/10261/182426 | DOI: | 10.1097/QAD.0000000000001050 | ISSN: | 0269-9370 | E-ISSN: | 1473-5571 |
Aparece en las colecciones: | (IBIS) Artículos |
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