@article{d671ef9cdba4466fa003c3c2b6fc83a4,
title = "Fungal infection as a risk factor for HIV disease progression among patients with a CD4 count above 200/microl in the era of cART",
abstract = "The identification of clinical risk factors for AIDS in patients with preserved immune function is of significant interest. We examined whether patients with fungal infection (FI) and CD4 cell count >or=200/microl were at higher risk of disease progression in the era of cART. 11,009 EuroSIDA patients were followed from their first CD4 cell count >or=200/microl after 1 January 1997 until progression to any non-azoles/amphotericin B susceptible (AAS) AIDS disease, last visit or death. Initiation of antimycotic therapy (AMT) was used as a marker of FI and was modelled as a time-updated covariate using Poisson regression. After adjustment for current CD4 cell count, HIV-RNA, starting cART and diagnosis of AAS-AIDS, AMT was significantly associated with an increased incidence of non-AAS-AIDS (IRR=1.55, 95% CI 1.17-2.06, p=0.0024). Despite low incidence of AIDS in the cART era, FI in patients with a CD4 cell count >or=200/microl is associated with a 55% higher risk of non-AAS-AIDS (95% confidence interval 1.17-2.06, p=0.0024). These data suggest that patients with FI are more immune compromized than would be expected from their CD4 cell count alone. FI can be used as a clinical marker for disease progression and indirect indicator for initiation/changing cART in settings where laboratory facilities are limited.",
keywords = "Adult, Anti-Retroviral Agents, Antifungal Agents, CD4 Lymphocyte Count, Disease Progression, Drug Therapy, Combination, Female, HIV Infections, Humans, Male, Middle Aged, Mycoses, Prospective Studies, Risk Factors",
author = "Daria Podlekareva and Amanda Mocroft and Ole Kirk and Peter Reiss and Pauls Aldins and Christine Katlama and Helen Kovari and Hans-Juergen Stellbrink and {D'Arminio Monforte}, Antonella and Lundgren, {Jens D} and NN NN",
year = "2008",
doi = "10.1080/00365540802227094",
language = "English",
volume = "40",
pages = "908--13",
journal = "Scandinavian Journal of Infectious Diseases",
issn = "0036-5548",
publisher = "Informa Healthcare",
number = "11-12",
}