markers of rapid hiv progression among untreated argentinean seroconverters m.e. socías, o. sued,...

Markers of rapid HIV progression among untreated Argentinean seroconverters

M.E. Socías, O. Sued, N. Laufer, H. Mingrone, C. Acuipil, E. Loiza, L. Amante, C. Remondegui, M. Lázaro, D. Pryluka, M. Cabrini, M.I. Figueroa, G. Turk, A. Gun, M.B. Bouzas, M.C. Iannella, H. Salomón, A. Krolewiecki, H. Pérez, P. Cahn, on behalf of Grupo Argentino de Seroconversión Study Group

Grupo Argentino de Seroconversión

FRAX0104


Background

• Diagnosis of Primary HIV Infection (PHI) has important clinical and public health implications.

• Indication of treatment at this stage remains controversial.

• Understanding early host-virus interactions may help develop new treatment and prevention strategies.


Cohort description• Multicenter Registry of PHI

patients started in 2008• 16 centers• 152 patients

HIV/AIDS in Argentina• 120,000 PLWHA• 60,000 know their status• 44% live in Buenos Aires city

and surroundings


Objectives

• To describe clinical and immunological outcomes and identify potential predictors of progression during the first year of infection among Argentinean seroconverters.


Material & Methods• Inclusion Criteria:

– >16 years old– Confirmed acute or recent HIV infection:

• Negative or Indeterminate WB plus positive virological test

• Positive WB plus negative HIV test within the previous 6 months

– HIV diagnosis between 1997-2008– ≥ 1 year of follow-up


Material & Methods• Definitions:

– “Symptomatic” PHI: ≥ 1 symptom associated with Acute Retroviral Syndrome (ARS).

– “Severe symptomatic” PHI: B or C events, or other non-AIDS related serious events at the time of seroconversion.

– HIV progression: • Clinical criteria: B or C event, or death• Immunological criteria: CD4 cell count < 350

cells/L


Baseline characteristics (n=134)• Sex: 109 male (81%), 25 female (3 pregnant)• Age, median: 32 years old (IQR 25-39)• Risk: MSM 53 %

Heterosexual 37%

IDU 1%

• HIV-test: Negative WB 9%

Indeterminate WB 40%

Seroconversion 51%

• 28 cases with HIV-positive partner• Median Viral load: 4.87 log copies/ml (IQR 4.11-5.51)• Median CD4: 479 cells/L (IQR 341-682)

Requested by patients in 33%


Morbidity and mortality associated with acute HIV infection

• Symptomatic PHI: 99 patients (74%)• Severe symptomatic PHI: 26 patients

– 7 Opportunistic infections– 9 B events– 10 non-AIDS defining serious events

• Hospital admission: 35 patients (26%)• 1 death (disseminated histoplasmosis)

Factors Associated with Severe Symptomatic PHI


n=26

Risk Factor OR 95%CI p

Age > 30 years 1.36 0.63-2.92 0.495

Male sex 2.52 0.63-10.04 0.246

Diagnosis ≥ 2005 0.79 0.37-1.70 0.619

MSM 1.14 0.51-2.55 0.58

HIV RNA > 100,000 copies/mL 3.72 1.58-8.77 0.001

CD4 cell-count < 350 cells/l 3.72 1.83-7.58 0.001

Diagnosis based on physician suspicion 5.06 1.83-14.04 <0.001


12-month follow-up

134 PHI patients

Initiated HAART

42

Progressed*

3 (7%)

Untreated

92

Progressed*: 24 (26%)

- Clinical: 12 (1 death)

- Immunological: 12

* HIV progression:- Clinical: B or C event, or death.- Immunological: CD4 < 350 cells/l.

p=0.01

Risk FactorUnivariate model Multivariate model

HR 95%CI p HR 95%CI p

Male sex 1.07 0.89-1.29 0.752 3.33 0.16-67.54 0.433

Diagnosis ≥ 2005 0.81 0.61 - 1.09 0.146 2.10 0.20-21.99 0.537

Age > 30 1.40 0.93-2.10 0.159 4.42 0.91-21.47 0.065

MSM 1.38 1.02-1.86 0.081 0.99 0.11-8.64 0.995Baseline CD4 cell-count ≤ 350 cell/l 3.81 1.64-8.86 0.002 3.14 0.47-20.78 0.236

Baseline HIV RNA ≥ 100,000 copies/mL 1.91 1.08-3.39 0.043 16.4 1.74-154.6 0.015

HIV RNA at 6 months ≥ 100,000 copies/mL

9.88 1.30-75.20 0.008 2.24 0.19-26.14 0.520

Symptomatic PHI 1.40 0.48-4.03 0.742 9.23 1.2-72.4 0.034

Predictors of Disease Progression in untreated patients


n=92


Time to Progression of HIV Disease Among Untreated Patients

n=92

13%

34%

p=0.04


Conclusions• In our cohort, PHI was associated with

significant morbidity.• One quarter of untreated patients would

require HAART during the first year of HIV infection.

• Symptomatic PHI and high baseline VL were associated with more rapid HIV progression within the first year of infection.

• HAART should be considered in PHI-patients with ARS or high baseline VL.


SITESHospital FernándezFundación HuéspedCentro Médico HuéspedHospital MuñizHospital San Antonio de ArecoSanatorio OtamendiHospital de BarilocheHospital San Roque de JujuyNexo Asociación CivilSanatorio TrinidadHospital Aeronáutico de CórdobaSanatorio San LucasHospital de GuernicaAclires

LABORATORIESCNRSHoracio SalomónManuel Gomez CarrilloGabriela TurkDario DilerniaFUND HUESPEDAna GunH. MUÑIZM Belén BouzasInés ZapiolaH. FERNANDEZOsvaldo Cando

PHYSICIANSLorena AbusamraMarcela AcostaCarolina AcuipilViviana AlonsoLiliana AmanteGraciela BenAriel BravermanMercedes CabriniPedro CahnCecilia CánepaDaniel Cangelosi Juan CastelliMariana CeriottoCarina CesarMaría CollinsFabio CrudoAndrea DuarteGustavo EcheniqueM Inés FigueroaValeria Fink

Claudia GallosoPalmira GardaAlejandro KrolewieckiNatalia LauferMarita LázaroAlberto LeoniEliana LoizaHoracio MingroneMarcela OrtizPatricia PattersonHéctor PérezNorma PorteiroDaniel PrylukaCarlos Remondegui Raúl RománM. Eugenia SocíasOmar SuedJ Gonzalo TomásJavier YaveCarlos Zala

Grupo Argentino de Seroconversión Study Group

We are in debt to all the patients of Grupo Argentino de Seroconversión.

Financial Support: Partially funded by Fogarty International Center (Grant # D43 TW 001037).


Thank you for your attention!!!

If you need more information please contact:

“Protocolo PHI”: Eugenia Socías

[email protected]

markers of rapid hiv progression among untreated argentinean seroconverters m.e. socías, o. sued,...

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