RT Dissertation/Thesis T1 Respuesta inmunológica discordante en pacientes con infección por el virus de la inmunodeficiencia humana no tratados previamente que inician terapia antirretroviral de gran actividad (TARGA): prevalencia, factores predictores y evolución clínica A1 Tamargo Chamorro, Lara María AB Since the introduction of highly active antiretroviral therapy the prognostic of patientswith HIV infection has been improved significantly. We know that most patients who startHAART achieve a complete immunovirological response but about 10-30% of patients,according published studies, presents a poor CD4 T cell increment despite indetectable HIVviral load (discordant immunological response, DIR).The definition of DIR and thecharacteristics of patients included in published studies, are heterogeneous and it is difficult toreach a conclusion respect the prevalence, independent associated factors and clinical outcomesin patients with DIR. We included 272 naïve-antiretroviral HIV infected patients in aretrospective cohorts study, who started antiretroviral therapy with a HAART regimen in theHIV Unit of Hospital Universitario 12 de Octubre in Madrid between January 1997 and January2003. The patients included presented a complete HIV viral load suppression at least in twoconsecutive determinations during the first year of follow-up and one of them at month 12. Theselected patients had no any concomitant immunossupresor therapy. Epidemiolgy, clinical,biological and therapeutic variables were collected at baseline visit and the patients werefollowed-up every 4 months and the determinations of CD4 cell counts, HIV viral load andopportunistics diseases (CDC guidelines, Atlanta 1993) were specifically collected too. Thepatients were followed-up until 24 months on HAART were completed or until two consecutiveHIV viral load were detectable, the suspension of HAART were necessary or the patient werelost during the follow-up or dead. DIR was defined as the increment in CD4 cell counts less orsimilar to 100cell/mm3 respect baseline count despite indetectable HIV viral load at month 12on HAART. The study aims were to analyze the DIR prevalence at months 12 and 24, theindependent associated factors to DIR and describe the clinical outcomes observed in patientswith DIR. We analyzed the same goals in patients with less than 200 CD4 cell/mm3 counts atbaseline. The prevalence of DIR was 33% at month12 and 18% at month 24. The independentassociated factors to DIR were a minor baseline HIV viral load (RR=0.52, IC95%=0.33-0.81,p=0.004), HCV co-infection (RR=2.28, IC95%=1.24-4.19, p=0.008) and d4T versus AZTtreatment (RR=0.48, IC95%=0.25-0.89, p=0.02) at month12 and a minor baseline HIV viralload (RR=0.48, IC95%=0.26-0.90, p=0.02), HCV co-infection (RR=2.81, IC95%=1.19-6.61,p=0.01) and a mayor baseline CD4 cell counts (RR=1.36, IC95%=1.09-1.69, p=0.005) at month24. The opportunistic diseases incidence was 8.4% and there were no significant statisticaldifferences between patients with and without DIR. The patients with severe baselineimmunodepression had a prevalence of DIR of 33% and 11% at months 12 and 24 respectively;the independent associated factor to DIR was d4T versus AZT treatment (RR=0.41,IC95%=0.19-0.87, p=0.02) at month 12 and no independent associated factor were observed atmonth 24; the opportunistic diseases incidence was 8.7% and no significant statisticaldifferences were observed between patients with and without DIR. PB Universidad Complutense de Madrid, Servicio de Publicaciones YR 2010 FD 2010-09-09 LK https://hdl.handle.net/20.500.14352/47415 UL https://hdl.handle.net/20.500.14352/47415 LA spa NO Tesis de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Medicina, leída el 28-04-2009 DS Docta Complutense RD 15 may 2024