LOS ANGELES — The risk of nonopportunistic diseases in HIV-infected patients increases as CD4 counts fall, and the impact of such diseases overshadows that of opportunistic diseases at CD4 counts above 200 cells/mcL, said Dr. Jason Baker of the University of Minnesota in Minneapolis.
The discovery that rates of nonopportunistic diseases vary according to CD4 counts “starts to build a case that people aren't just … living longer and … dying of other causes,” Dr. Baker said at a press conference following his presentation at the 14th Conference on Retroviruses and Opportunistic Infections.
Rates of liver, renal, and cardiovascular diseases, as well as of non-HIV-related cancers, were all associated with CD4 counts in a group of 1,397 patients followed for at least 5 years after enrollment in a study sponsored by the National Institutes of Health.
Dr. Baker and his associates randomly assigned ART-naive patients to one of three drug regimens and carefully monitored all fatal and nonfatal opportunistic and nonopportunistic events.
Over the 5-year follow-up, there were 266 opportunistic disease events with 89 related deaths and 166 nonopportunistic disease events with 25 deaths.
Nonopportunistic diseases seen in the cohort included cirrhosis and grade 4 transaminitis; myocardial infarctions, strokes, and coronary artery disease requiring intervention; renal insufficiency and end-stage renal disease; and 32 malignancies other than non-Hodgkin's lymphoma or Kaposi's sarcoma, including five cases each of anal, lung, and skin cancers.
Liver disease disproportionately included grade 4 elevated liver enzymes, which may be related to medications. Whether or not this diagnosis was included in the analysis, however, CD4 counts were related to disease events. Both opportunistic and nonopportunistic events were less likely in patients with higher CD4 counts.
“The decline was steeper for opportunistic disease events, but nonopportunistic disease became at least as significant if not more so at higher CD4 levels,” Dr. Baker said at the conference, sponsored by the Foundation for Retrovirology and Human Health.
Above CD4 counts of 200 cells/mcL, mortality and morbidity were higher for nonopportunistic than opportunistic disease, he said.
The univariate hazard ratios for the difference in risk for an incremental increase of 100 cells/mcL in the CD4 count was 0.49 for opportunistic disease and 0.78 for nonopportunistic disease, and remained powerful (0.57 and 0.84, respectively) even after adjustment for age, sex, race, prior AIDS, hepatitis B and C, baseline CD4 and RNA viral load, and latest RNA viral load, Dr. Backer said.