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.