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  16th CROI
Conference on Retroviruses and Opportunistic Infections Montreal, Canada
February 8-11, 2009
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Non-AIDS Illness More Common Than AIDS--and More Deadly--in EuroSIDA
  16th Conference on Retroviruses and Opportunistic Infections, February 8-11, 2009, Montreal
Mark Mascolini
Since January 2002, non-AIDS diagnoses proved more common than AIDS diagnoses in 10,341 EuroSIDA cohort members, and non-AIDS diseases killed substantially more people than AIDS [1]. New diagnoses of non-AIDS illnesses exceeded diagnoses of AIDS among people with CD4 counts above 100 and in those with better-controlled viral replication.
EuroSIDA investigators recorded the incidence (new diagnoses) of AIDS-defining conditions and non-AIDS illnesses in all cohort members with follow-up after January 1, 2002. Non-AIDS illnesses considered were malignancies, end-stage renal disease, liver failure, pancreatitis, and cardiovascular disease (including acute myocardial infarction or stroke). They did not count recurrences of AIDS or non-AIDS diseases.
The researchers tallied 684 non-AIDS diagnoses for an incidence of 16.5 per 1000 person-years and 641 AIDS diagnoses for an incidence of 15.5 per 1000 person-years. While 219 people (34.5%) with a new AIDS diagnosis died, 316 (46.5%) with a non-AIDS diagnosis died. Malignancies, cardiovascular disease, and liver failure were the most common non-AIDS illnesses. Esophageal candidiasis, Pneumocystis pneumonia, and pulmonary tuberculosis were the most common AIDS conditions.
Current median CD4 count, viral load, and age differed strikingly in people with a non-AIDS diagnosis and those with a new AIDS diagnosis:
• CD4 count: 328 (interquartile range [IQR] 177-533) non-AIDS, 198 (IQR 63-370) AIDS
• Viral load: 1.77 log (IQR 1.69-3.52) non-AIDS, 4.08 (IQR 1.92-5.11) AIDS (about 50 versus 10,000 copies)
• Age: 47.7 (IQR 41.8-56.6) non-AIDS, 41.1 (IQR 34.9-47.4) AIDS
In an adjusted analysis, however, people with a latest CD4 count twice that of a comparable patient had a 23% lower incidence of a non-AIDS illness (P < 0.0001). People who spent more than 2 years with a CD4 count below 200 had a 40% higher incidence of non-AIDS illness (P = 0.017). Every 10-fold higher viral load raised the incidence of a non-AIDS diagnosis 11% (P = 0.017).
Other factors that significantly increased the incidence of non-AIDS diagnoses were every added 10 years of age (incidence rate ratio [IRR] 1.68, P < 0.0001), coinfection with hepatitis B (IRR 1.52, P = 0.0017), coinfection with hepatitis C (IRR 1.41, P = 0.0081), diabetes (IRR 1.56, P = 0.0001), hypertension (IRR 1.40, P < 0.0001), current smoking (IRR 1.74, P < 0.0001), anemia (IRR 2.11, P < 0.0001), and AIDS (IRR 1.35, P = 0.0007).
Diabetes, hypertension, and hepatitis B or C did not correlate with a higher incidence of AIDS diagnoses. Current CD4 count and viral load were much stronger predictors of AIDS in EuroSIDA, though more than 2 years with a CD4 count below 200 did not correlate with a higher AIDS incidence.
Amanda Mocroft and EuroSIDA colleagues urged researchers to report non-AIDS diagnoses and deaths routinely in clinical trials and observational studies. "The risk factor profile for non-AIDS-defining illnesses was diverse," they added, "with multiple potentially modifiable immunodeficiency and lifestyle-related risk factors."
1. Mocroft A, Reiss P, Gasiorowski J, et al. Serious fatal and non-fatal non-AIDS defining illnesses (non-ADI) in Europe. 16th Conference on Retroviruses and Opportunistic Infections, February 8-11, 2009, Montreal. Abstract 707.