Group updates model of HIV prognosis for those who start HAART

The Antiretroviral Therapy Cohort Collaboration has issued an updated model for gauging prognosis that they say has "high discriminatory power" for patients with HIV-1 infection who are starting highly active antiretroviral therapy.

NEW YORK (Reuters Health) Jun 27 - The Antiretroviral Therapy Cohort Collaboration has issued an updated model for gauging prognosis that they say has "high discriminatory power" for patients with HIV-1 infection who are starting highly active antiretroviral therapy (HAART).

A description of the model is published in the May 31st issue of AIDS.

Dr. Margaret May of the University of Bristol, UK, and collaborators conducted a comprehensive data analysis from 12 cohorts in Europe and North America consisting of 20,379 HIV-1-infected individuals between 1995 and 2003.

The investigators used survival models to predict the incidence of a new AIDS-defining event or death or death alone at 5 years after beginning HAART. Similar calculations were done from 6 months after beginning HAART.

During 61,798 person years of follow-up, there were 1,005 deaths and an additional 1,303 new cases of AIDS.

Nearly half (49%) of patients started HAART when their CD4 cell counts were less than 200 cells/microliter or after a diagnosis of AIDS.

The 5-year risk of AIDS or death from the start of HAART ranged from 5.0.% to 77.0%., and for death alone from 1.8% to 65.0%, depending on age, CD4 cell count, HIV-1-RNA level, clinical stage and history of injection drug use.

When calculations were made starting 6 months after the start of HAART, risk of AIDS or death ranged from 4.1% to 99% and for death alone, from 1.3% to 96%.

A risk calculator for estimating AIDS progression after starting HAART can be found at www.art-cohort-collaboration.org.

"Information on prognosis is required to counsel patients who start HAART, to investigate the treated history of HIV-1 infection, and to inform treatment guidelines," the ART Cohort Collaborators write. The current update of the ART Cohort Collaboration database "makes it possible to extend earlier analyses and estimate the cumulative incidence of AIDS or death and death from all causes up to five years after starting HAART."

The ART Cohort Collaborators found that more than half of new cases of HIV-1 infection are spread by individuals who are unaware of their infection status.

"Many opportunities for earlier diagnosis are missed," the authors note.

AIDS 2007;21:1185-1197.