Opportunistic events shortly after beginning HAART in HIV-infected patients

BACKGROUND: We aimed at analysing the incidence and characteristics of opportunistic events (OE) within a few months after starting highly active antiretroviral therapy (HAART) in HIV infected patients. PATIENTS AND METHOD: Retrospective study of HIV infected outclinic patients attended in a HIV/AIDS reference hospital in Madrid who initiated HAART during the second semester of 1998, with a baseline CD4 cell count < 250 x 10(6) cells/l. We recorded the incidence of OE within 6 months after begining HAART and analysed virological and immunological parameters, sociodemographic variables and types of antiretroviral treatment. RESULTS: The study included 269 patients. Twenty-one (7.8%) OE were recorded. At the onset of HAART, the mean CD4 cell count in these 21 patients was 137 (92) x10(6)/l and the median viral load was 24,043 cop/ml. At the time of OE diagnosis, these parameters were 218 (114) x 10 (6)/l (p = 0.012) and < 500 cop/ml, respectively. OE were distributed as follows: herpes zoster, 9 cases (43%), Pneumocystis carinii pneumonia, 5 cases (24%), Kaposi sarcoma, 3 cases (14%) and tuberculosis, cerebral toxoplasmosis, cytomegalovirus retinitis, and non-Hodgkin lymphoma, 1 case each. Overall, of OE occurred within first 4 months after begining HAART. In addition, an OE was developed by. 8% patients treated with NRTI and PI, 2% treated with NRTI and NNRTI, and 10% treated with NRTI, NNRTI and Pl (p=0.44). CONCLUSIONS: HIV-infected subjects with low CD4 counts are prone to develop OE within the first few moths after begining HAART. An inflammatory response to latent antigens due to the immune recovery might explain this fact. Therefore prophylaxis against opportunistic pathogens should not be discontinued soon after begining HAART. Moreover, the development of OE in these patients should not be interpreted as a failure of the antiretroviral therapy which, otherwise, needs to be continued.