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Mocroft A, Pelchen-Matthews A, Hoy J, Llibre JM, Neesgaard B, Jaschinski N, Domingo P, Rasmussen LD, Günthard HF, Surial B, Öllinger A, Knappik M, de Wit S, Wit F, Mussini C, Vehreschild J, Monforte AD, Sonnerborg A, Castagna A, Anne AV, Vannappagari V, Cohen C, Greaves W, Wasmuth JC, Spagnuolo V, Ryom L. Heavy antiretroviral exposure and exhausted/limited antiretroviral options: predictors and clinical outcomes. AIDS 2024; 38:497-508. [PMID: 38079588 DOI: 10.1097/qad.0000000000003798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
OBJECTIVES People with HIV and extensive antiretroviral exposure may have limited/exhausted treatment options (LExTO) due to resistance, comorbidities, or antiretroviral-related toxicity. Predictors of LExTO were investigated in the RESPOND cohort. METHODS Participants on ART for at least 5 years were defined as having LExTO when switched to at least two anchor agents and one third antiretroviral (any class), a two-drug regimen of two anchor agents (excluding rilpivirine with dolutegravir/cabotegravir), or at least three nucleoside reverse transcriptase inhibitors. Baseline was the latest of January 1, 2012, cohort enrolment or 5 years after starting antiretrovirals. Poisson regression modeled LExTO rates and clinical events (all-cause mortality, non-AIDS malignancy, cardiovascular disease [CVD], and chronic kidney disease [CKD]). RESULTS Of 23 827 participants, 2164 progressed to LExTO (9.1%) during 130 061 person-years follow-up (PYFU); incidence 1.66/100 PYFU (95% CI 1.59-1.73). Predictors of LExTO were HIV duration more than 15 years (vs. 7.5-15; adjusted incidence rate ratio [aIRR] 1.32; 95% CI 1.19-1.46), development of CKD (1.84; 1.59-2.13), CVD (1.64; 1.38-1.94), AIDS (1.18; 1.07-1.30), and current CD4 + cell count of 350 cells/μl or less (vs. 351-500 cells/μl, 1.51; 1.32-1.74). Those followed between 2018 and 2021 had lower rates of LExTO (vs. 2015-2017; 0.52; 0.47-0.59), as did those with baseline viral load of 200 cp/ml or less (0.46; 0.40-0.53) and individuals under 40. Development of LExTO was not significantly associated with clinical events after adjustment for age and current CD4, except CKD (1.74; 1.48-2.05). CONCLUSION Despite an aging and increasingly comorbid population, we found declining LExTO rates by 2018-2021, reflecting recent developments in contemporary ART options and clinical management. Reassuringly, LExTO was not associated with a significantly increased incidence of serious clinical events apart from CKD.
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Affiliation(s)
- Amanda Mocroft
- CHIP, Section 2100, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, University College London, London, UK
| | - Annegret Pelchen-Matthews
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, University College London, London, UK
| | - Jennifer Hoy
- Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne, Victoria, Australia
| | - Josep M Llibre
- Department of Infectious Diseases, Hospital Universitari Germans Trias i Pujol
| | - Bastian Neesgaard
- CHIP, Section 2100, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Nadine Jaschinski
- CHIP, Section 2100, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Pere Domingo
- Department of Infectious Diseases, Hospital of the Holy Cross and Saint Paul, Barcelona, Spain
| | | | - Huldrych F Günthard
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich
- Institute of Medical Virology, University of Zurich, Zurich
| | - Bernard Surial
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Angela Öllinger
- Department of Dermatology and Venerology, Kepler University Hospital, Linz
| | - Michael Knappik
- Department of Respiratory Medicine, Klinik Penzing, Vienna, Austria
| | - Stephane de Wit
- CHU Saint-Pierre, Centre de Recherche en Maladies Infectieuses a.s.b.l., Brussels, Belgium
| | - Ferdinand Wit
- AIDS Therapy Evaluation in the Netherlands (ATHENA) cohort, HIV Monitoring Foundation, Amsterdam, the Netherlands
| | - Cristina Mussini
- Modena HIV Cohort, Università degli Studi di Modena, Modena, Italy
| | - Joerg Vehreschild
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | | | - Anders Sonnerborg
- Swedish InfCare HIV Cohort, Karolinska University Hospital, Karolinska, Sweden
| | - Antonella Castagna
- San Raffaele Scientific Institute, Università Vita-Salute San Raffaele, Milan, Italy
| | | | | | | | | | | | - Vincenzo Spagnuolo
- San Raffaele Scientific Institute, Università Vita-Salute San Raffaele, Milan, Italy
| | - Lene Ryom
- CHIP, Section 2100, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Diseases 144, Hvidovre University Hospital
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Fursa O, Reekie J, Kuzin I, Hetman L, Kryshchuk A, Starychenko O, Hrytsaiuk N, Khodus I, Nyzhnyk A, Rakhuba V, Kovalevska M, Maistat T, Pryhoda I, Ahieieva M, Varvarovska O, Valdenmaiier O, Lundgren J, Peters L. Cross-sectional HIV and HCV cascades of care across the regions of Ukraine between 2019 and 2020: findings from the CARE cohort. J Int AIDS Soc 2023; 26:e26166. [PMID: 37705358 PMCID: PMC10500257 DOI: 10.1002/jia2.26166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 08/23/2023] [Indexed: 09/15/2023] Open
Abstract
INTRODUCTION Eastern Europe is facing major HIV and hepatitis C (HCV) epidemics, with many people living with HIV (PLHIV) and HIV/HCV coinfection living in Ukraine. Despite the previous progress towards care quality improvement, the ongoing war in Ukraine is disrupting HIV and HCV care. METHODS We described an HIV cascade of care (CoC) in PLHIV from two clinical sites and an HCV CoC for anti-HCV-positive PLHIV from six sites in Ukraine, enrolled in the CARE cohort between 1 January 2019 and 1 June 2020. The cross-sectional HIV CoC and HCV CoC are described at study enrolment. RESULTS Of 1028 PLHIV, 1014 (98.6%, 95% confidence interval [CI] 97.7-99.3) were on antiretroviral therapy (ART), and 876 (86.4% of those on ART, 95% CI 84.1-88.4) were virologically suppressed. Of 894 participants on ART >6 months, 90.8% (95% CI 88.7-92.6) were virologically suppressed (HIV-RNA <200 copies/ml). Of 2040 anti-HCV-positive PLHIV, 417 (20.4%, 95% CI 18.7-22.3) were ever tested for HCV-RNA prior to enrolment, ranging from 4.9% to 54.4% across sites, and 13.5% were currently HCV-RNA positive. One hundred and eighteen persons (7.3% of ever chronically infected) had received HCV treatment, and 25 persons (1.6% of ever chronically infected) were cured, with variations across sites (0%-7.5%). The site diagnosing 54.4% of people with chronic HCV was the only one providing free RNA testing for all anti-HCV-positive persons, while the intra-country differences in treatment coverage were driven by the number of available direct-acting antiviral (DAA) courses. CONCLUSIONS Over 98% of PLHIV in care in both CARE sites in Ukraine were receiving ART, and the target of 90% virally suppressed was achieved in persons >6 months on ART. Only one of six HIV/HCV study sites tested over 50% anti-HCV-positive PLHIV for HCV-RNA and treated over 25% of eligible persons. While free HCV-RNA testing and DAA treatment are paramount to achieving HCV elimination targets, they remained a challenge in Ukraine in 2019-2020. The extent of the HIV and HCV care disruption during the war will be further assessed in the CARE cohort and compared with the pre-war findings.
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Affiliation(s)
- Olga Fursa
- Centre of Excellence for Health, Immunity and InfectionsRigshospitaletCopenhagenDenmark
| | - Joanne Reekie
- Centre of Excellence for Health, Immunity and InfectionsRigshospitaletCopenhagenDenmark
| | - Ihor Kuzin
- Public Health Center of the Ministry of Health of UkraineKyivUkraine
| | - Larysa Hetman
- Public Health Center of the Ministry of Health of UkraineKyivUkraine
| | - Alina Kryshchuk
- Public Health Center of the Ministry of Health of UkraineKyivUkraine
| | - Olena Starychenko
- Kyiv City AIDS Prevention and Control Center (Kyiv City Clinical Hospital №5)KyivUkraine
| | - Nana Hrytsaiuk
- Kyiv City AIDS Prevention and Control Center (Kyiv City Clinical Hospital №5)KyivUkraine
| | - Inna Khodus
- Kyiv Regional Center for Public HealthKyivUkraine
| | - Alla Nyzhnyk
- Kyiv Regional Center for Public HealthKyivUkraine
| | | | | | - Tetiana Maistat
- Regional Clinical Center for AIDS Prevention and Control of Kharkiv Regional CouncilKharkivUkraine
| | - Iryna Pryhoda
- Mariupol City Hospital №4 named after I.K. MatsukaMariupolUkraine
| | | | - Olena Varvarovska
- Regional Medical Specialized Center of Zhytomyr Regional CouncilZhytomyrUkraine
| | - Olena Valdenmaiier
- Centre of Excellence for Health, Immunity and InfectionsRigshospitaletCopenhagenDenmark
| | - Jens Lundgren
- Centre of Excellence for Health, Immunity and InfectionsRigshospitaletCopenhagenDenmark
| | - Lars Peters
- Centre of Excellence for Health, Immunity and InfectionsRigshospitaletCopenhagenDenmark
| | - the CARE study group
- Centre of Excellence for Health, Immunity and InfectionsRigshospitaletCopenhagenDenmark
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Martín-Iguacel R, Vazquez-Friol MC, Burgos J, Bruguera A, Reyes-Urueña J, Moreno-Fornés S, Aceitón J, Díaz Y, Domingo P, Saumoy M, Knobel H, Dalmau D, Borjabad B, Johansen IS, Miro JM, Casabona J, Llibre JM. Cardiovascular events in delayed presentation of HIV: the prospective PISCIS cohort study. Front Med (Lausanne) 2023; 10:1182359. [PMID: 37415770 PMCID: PMC10321350 DOI: 10.3389/fmed.2023.1182359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 05/22/2023] [Indexed: 07/08/2023] Open
Abstract
Objectives People with HIV (PWH) have a higher cardiovascular risk than the general population. It remains unclear, however, whether the risk of cardiovascular disease (CVD) is higher in late HIV presenters (LP; CD4 ≤ 350 cells/μL at HIV diagnosis) compared to PWH diagnosed early. We aimed to assess the rates of incident cardiovascular events (CVEs) following ART initiation among LP compared to non-LP. Methods From the prospective, multicentre PISCIS cohort, we included all adult people with HIV (PWH) initiating antiretroviral therapy (ART) between 2005 and 2019 without prior CVE. Additional data were extracted from public health registries. The primary outcome was the incidence of first CVE (ischemic heart disease, congestive heart failure, cerebrovascular, or peripheral vascular disease). The secondary outcome was all-cause mortality after the first CVE. We used Poisson regression. Results We included 3,317 PWH [26 589.1 person/years (PY)]: 1761 LP and 1556 non-LP. Overall, 163 (4.9%) experienced a CVE [IR 6.1/1000PY (95%CI: 5.3-7.1)]: 105 (6.0%) LP vs. 58 (3.7%) non-LP. No differences were observed in the multivariate analysis adjusting for age, transmission mode, comorbidities, and calendar time, regardless of CD4 at ART initiation [aIRR 0.92 (0.62-1.36) and 0.84 (0.56-1.26) in LP with CD4 count <200 and 200- ≤ 350 cells/μL, respectively, compared to non-LP]. Overall mortality was 8.5% in LP versus 2.3% in non-LP (p < 0.001). Mortality after the CVE was 31/163 (19.0%), with no differences between groups [aMRR 1.24 (0.45-3.44)]. Women vs. MSM and individuals with chronic lung and liver disease experienced particularly high mortality after the CVE [aMRR 5.89 (1.35-25.60), 5.06 (1.61-15.91), and 3.49 (1.08-11.26), respectively]. Sensitivity analyses including only PWH surviving the first 2 years yielded similar results. Conclusion CVD remains a common cause of morbidity and mortality among PWH. LP without prior CVD did not exhibit an increased long-term risk of CVE compared with non-LP. Identifying traditional cardiovascular risk factors is essential for CVD risk reduction in this population.
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Affiliation(s)
- Raquel Martín-Iguacel
- Centre of Epidemiological Studies of HIV/AIDS and STI of Catalonia (CEEISCAT), Health Department, Generalitat de Catalunya, Badalona, Spain
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
| | | | - Joaquin Burgos
- Department of Infectious Diseases, Hospital Universitari de la Vall d'Hebron, Barcelona, Spain
| | - Andreu Bruguera
- Centre of Epidemiological Studies of HIV/AIDS and STI of Catalonia (CEEISCAT), Health Department, Generalitat de Catalunya, Badalona, Spain
- CIBER Epidemiologia y Salud Pública (CIBERESP), Madrid, Spain
- Department of Paediatrics, Obstetrics and Gynecology and Preventive Medicine, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Juliana Reyes-Urueña
- Centre of Epidemiological Studies of HIV/AIDS and STI of Catalonia (CEEISCAT), Health Department, Generalitat de Catalunya, Badalona, Spain
| | - Sergio Moreno-Fornés
- Centre of Epidemiological Studies of HIV/AIDS and STI of Catalonia (CEEISCAT), Health Department, Generalitat de Catalunya, Badalona, Spain
- CIBER Epidemiologia y Salud Pública (CIBERESP), Madrid, Spain
| | - Jordi Aceitón
- Centre of Epidemiological Studies of HIV/AIDS and STI of Catalonia (CEEISCAT), Health Department, Generalitat de Catalunya, Badalona, Spain
| | - Yesika Díaz
- Centre of Epidemiological Studies of HIV/AIDS and STI of Catalonia (CEEISCAT), Health Department, Generalitat de Catalunya, Badalona, Spain
| | - Pere Domingo
- Infectious Diseases Unit, Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Maria Saumoy
- Department of Internal Medicine and Infectious Diseases, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Hernando Knobel
- Department of Infectious Diseases, Hospital del Mar- Parc de Salut MAR, Barcelona, Spain
| | - David Dalmau
- Department of Internal Medicine, Hospital Universitari Mútua Terrassa, Barcelona, Spain
| | - Beatriz Borjabad
- Department of Internal Medicine, Consorci Sanitari Integral, Hospitalet del Llobregat, Barcelona, Spain
| | | | - Jose M. Miro
- Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Jordi Casabona
- Centre of Epidemiological Studies of HIV/AIDS and STI of Catalonia (CEEISCAT), Health Department, Generalitat de Catalunya, Badalona, Spain
- CIBER Epidemiologia y Salud Pública (CIBERESP), Madrid, Spain
- Department of Paediatrics, Obstetrics and Gynecology and Preventive Medicine, Universitat Autònoma de Barcelona, Badalona, Spain
- Fundació Institut D'investigació en Ciències de la Salut Germans Trias I Pujol (IGTP), Badalona, Spain
| | - Josep M. Llibre
- Infectious Diseases Department, University Hospital Germans Trias i Pujol, Barcelona, Spain
- Fight Infections Foundation, Barcelona, Spain
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Zhong M, Li M, Qi M, Su Y, Yu N, Lv R, Ye Z, Zhang X, Xu X, Cheng C, Chen C, Wei H. A retrospective clinical study of dolutegravir- versus efavirenz-based regimen in treatment-naïve patients with advanced HIV infection in Nanjing, China. Front Immunol 2023; 13:1033098. [PMID: 36700216 PMCID: PMC9868135 DOI: 10.3389/fimmu.2022.1033098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 12/14/2022] [Indexed: 01/11/2023] Open
Abstract
Currently, there are limited data related to the efficacy and safety of ART regimens, as well as factors influencing immune recovery in antiretroviral therapy (ART)-naïve patients with advanced HIV infection, especially in China. We designed a single-center, retrospective cohort study from March 1, 2019, to May 31, 2022, at The Second Hospital of Nanjing, China. ART-naïve adults with advanced HIV infection (CD4+ T-cell count < 200 cells/μL) who met the study criteria were included. The plasma viral load (VL), CD4+ T-cell count, CD4/CD8 ratio, treatment discontinuation, and immune reconstitution inflammatory syndrome (IRIS) events were collected to compare the efficacy and safety of the dolutegravir (DTG) and the efavirenz (EFV) regimens. Factors of immune recovery were analyzed using the Cox regression model. Study enrolled 285 ART-naïve adults with advanced HIV-1 infection, of which 95 (33.3%) started regimens including DTG and 190 (66.7%) were treated with EFV. After ART initiation, the proportion of patients with HIV-1 RNA < 50 copies/mL was higher (22.5% versus 6.5%, P < 0.001) in those on DTG-based regimens at month 1, but no significant difference at other follow-up points. Compared to the baseline, the median CD4+ T-cell count and CD4/CD8 ratio increased significantly during follow-up both in the EFV and the DTG groups. However, the CD4+ T-cell count increased greater in patients on DTG-based regimens at months 6, 12, 24, and 36 (P < 0.05). A total of 52 (18.2%) patients discontinued treatment, with no significant difference between ART regimens in treatment discontinuation rates. Only 7 patients reported IRIS, without significant difference between ART regimens (P=0.224). Overall, 34.0% (97/285) achieved a CD4+ T-cell count ≥ 350 cells/μL during follow-up. Age (P < 0.001), baseline CD4+ T-cell count (P < 0.001), baseline VL (P < 0.001) and ART regimens (P = 0.019) were associated with the CD4+ T-cell count ≥ 350 cells/μL after adjusting for potential confounders. Among ART-naïve adults with advanced HIV infection, it appeared that DTG-based regimens were better options for initial therapy compared to regimens including EFV; in addition, ART regimens, age, baseline VL and CD4+ T-cell count were associated with immune recovery.
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Affiliation(s)
- Mingli Zhong
- Department of Infectious Disease, The Second Hospital of Nanjing, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Mengqing Li
- Department of Infectious Disease, The Second Hospital of Nanjing, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Mingxue Qi
- Department of Infectious Disease, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Yifan Su
- Department of Infectious Disease, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Nawei Yu
- Department of Infectious Disease, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Ru Lv
- Department of Infectious Disease, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Zi Ye
- Department of Infectious Disease, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Xiang Zhang
- Department of Infectious Disease, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Xinglian Xu
- Department of Infectious Disease, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Cong Cheng
- Department of Infectious Disease, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Chen Chen
- Department of Infectious Disease, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, China,*Correspondence: Hongxia Wei, ; Chen Chen,
| | - Hongxia Wei
- Department of Infectious Disease, The Second Hospital of Nanjing, School of Public Health, Nanjing Medical University, Nanjing, China,*Correspondence: Hongxia Wei, ; Chen Chen,
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Ayal MA, Berha AB. Comparative Safety and Changes in Immunologic and Virologic Parameters of Dolutegravir versus Efavirenz-Based Antiretroviral Therapies Among HIV Patients: A Retrospective Cohort Study. HIV AIDS (Auckl) 2023; 15:173-190. [PMID: 37139483 PMCID: PMC10150766 DOI: 10.2147/hiv.s396420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 04/07/2023] [Indexed: 05/05/2023] Open
Abstract
Background In combination with other two antiretroviral drugs, an efavirenz (EFV) or dolutegravir (DTG)-based regimen is the treatment of choice for human immunodeficiency virus (HIV) infection. This study aimed to determine the safety and changes in immunologic and virologic parameters of DTG compared with EFV-based ART as first-line HIV treatment among HIV patients. Methods A retrospective hospital-based cohort study was carried out from September 1, 2019 to August 30, 2020 at HIV clinics of three selected hospitals in North-West-East Ethiopia, Amhara Region. All HIV patients ≥3 years old, who had been on either DTG or EFV-based combination anti-retroviral therapy (cART), and had detectable viral load (VL) were included. Descriptive and multivariate Cox regression analyses were used. Results Overall, 990 HIV patients were included in the analysis (DTG n=694, EFV n=296). A VL of <50 copies/mL was observed in 69% of patients in the DTG group and 66% in the EFV group (crude hazard ratio [CHR] =1.28, 95% CI: 1.08-1.51; p=0.004). Out of the total, 289 (42%) of the patients in the DTG group reported adverse drug events (ADEs) compared with 147 (50%) in the EFV group (p=0.020). Younger age, opportunistic infections (OIs), bed-ridden condition, no prophylaxis for OIs, low baseline cluster of differentiation 4 (CD4) count, high baseline VL, poor adherence, and ADEs were predictors of poor survival, and younger age, OIs, low baseline CD4, DTG-based initial regimen, poor adherence with cART, naïve treatment history, and student job type were predictors of poor safety outcomes. Conclusion The DTG-based regimen demonstrates an improved viral suppression and CD4 cell recovery, and better safety profile compared with the EFV-based regimen for the treatment of HIV-infected patients. A baseline CD4+ T-cell count <200 cells/mm3, OIs, and poor adherence with therapy were factors associated with poor survival and safety outcomes. HIV patients with these risk factors should be treated and monitored regularly.
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Affiliation(s)
- Melese Alemnew Ayal
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Alemseged Beyene Berha
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Correspondence: Alemseged Beyene Berha, Email
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6
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Martin-Iguacel R, Reyes-Urueña J, Bruguera A, Aceitón J, Díaz Y, Moreno-Fornés S, Domingo P, Burgos-Cibrian J, Tiraboschi JM, Johansen IS, Álvarez H, Miró JM, Casabona J, Llibre JM. Determinants of long-term survival in late HIV presenters: The prospective PISCIS cohort study. EClinicalMedicine 2022; 52:101600. [PMID: 35958520 PMCID: PMC9358427 DOI: 10.1016/j.eclinm.2022.101600] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 07/15/2022] [Accepted: 07/15/2022] [Indexed: 12/30/2022] Open
Abstract
Background Late HIV diagnosis (i.e CD4≤350 cells/µL) is associated with poorer outcomes. However, determinants of long-term mortality and factors influencing immune recovery within the first years after antiretroviral treatment (ART) initiation are poorly defined. Methods From PISCIS cohort, we included all HIV-positive adults, two-year survivors after initiating ART between 2005-2019. The primary outcome was all-cause mortality according to the two-year CD4 count. We used Poisson regression. The secondary outcome was incomplete immune recovery (i.e., two-year CD4<500 cells/µL). We used logistic regression and propensity score matching. Findings We included 2,719 participants (16593·1 person-years): 1441 (53%) late presenters (LP) and 1278 non-LP (1145 non-LP with two-year CD4 count >500 cells/µL, reference population). Overall, 113 patients (4·2%) died. Mortality was higher among LP with two-year CD4 count 200-500 cells/µL (aMRR 1·95[95%CI:1·06-3·61]) or <200 cells/µL (aMRR 4·59[2·25-9·37]).Conversely, no differences were observed in participants with two-year CD4 counts >500 cells/µL, regardless of being initially LP or non-LP (aMRR 1·05[0·50-2·21]). Mortality rates within each two-year CD4 strata were not affected by the initial CD4 count at ART initiation (test-interaction, p = 0·48). The stronger factor influencing immune recovery was the CD4 count at ART initiation. First-line integrase-inhibitor-(INSTI)-based regimens were associated with reduced mortality compared to other regimens (aMRR 0·54[0·31-0·93]) and reduced risk of incomplete immune recovery in LP (aOR 0·70[0·52-0·95]). Interpretation Two-year immune recovery is a good early predictor of long-term mortality in LP after surviving the first high-risk 2 years. Nearly half experienced a favorable immune recovery with a life expectancy similar to non-LP. INSTI-based regimens were associated with higher rates of successful immune recovery and better survival compared to non-INSTI regimens. Funding Southern-Denmark University, Danish AIDS-foundation, and Region of Southern Denmark.
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Affiliation(s)
- Raquel Martin-Iguacel
- Centre of Epidemiological Studies of HIV/AIDS and STI of Catalonia (CEEISCAT), Health Department, Generalitat de Catalunya, Badalona, Spain
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
| | - Juliana Reyes-Urueña
- Centre of Epidemiological Studies of HIV/AIDS and STI of Catalonia (CEEISCAT), Health Department, Generalitat de Catalunya, Badalona, Spain
| | - Andreu Bruguera
- Centre of Epidemiological Studies of HIV/AIDS and STI of Catalonia (CEEISCAT), Health Department, Generalitat de Catalunya, Badalona, Spain
| | - Jordi Aceitón
- Centre of Epidemiological Studies of HIV/AIDS and STI of Catalonia (CEEISCAT), Health Department, Generalitat de Catalunya, Badalona, Spain
| | - Yesika Díaz
- Centre of Epidemiological Studies of HIV/AIDS and STI of Catalonia (CEEISCAT), Health Department, Generalitat de Catalunya, Badalona, Spain
| | - Sergio Moreno-Fornés
- Centre of Epidemiological Studies of HIV/AIDS and STI of Catalonia (CEEISCAT), Health Department, Generalitat de Catalunya, Badalona, Spain
| | - Pere Domingo
- Infectious Diseases Unit, Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Joaquín Burgos-Cibrian
- Department of Infectious Diseases, Hospital Universitari de la Vall d'Hebron, Barcelona, Spain
| | - Juan Manuel Tiraboschi
- Department of Internal Medicine and Infectious Diseases, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | | | | | - Josep M Miró
- Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Jordi Casabona
- Centre of Epidemiological Studies of HIV/AIDS and STI of Catalonia (CEEISCAT), Health Department, Generalitat de Catalunya, Badalona, Spain
- Department of Paediatrics, Obstetrics and Gynecology and Preventive Medicine, Universitat Autònoma de Barcelona, Badalona, Spain
- Fundació Institut D'investigació En Ciències De La Salut Germans Trias I Pujol (IGTP), Badalona, Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Josep M Llibre
- Infectious Diseases Department and Fight Infections Foundation, University Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - PISCIS study group
- Centre of Epidemiological Studies of HIV/AIDS and STI of Catalonia (CEEISCAT), Health Department, Generalitat de Catalunya, Badalona, Spain
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
- Infectious Diseases Unit, Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain
- Department of Infectious Diseases, Hospital Universitari de la Vall d'Hebron, Barcelona, Spain
- Department of Internal Medicine and Infectious Diseases, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
- Infectious Diseases Unit, University Hospital of Ferrol, Spain
- Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
- Department of Paediatrics, Obstetrics and Gynecology and Preventive Medicine, Universitat Autònoma de Barcelona, Badalona, Spain
- Fundació Institut D'investigació En Ciències De La Salut Germans Trias I Pujol (IGTP), Badalona, Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Infectious Diseases Department and Fight Infections Foundation, University Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
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Byonanebye DM, Polizzotto MN, Neesgaard B, Sarcletti M, Matulionyte R, Braun DL, Castagna A, de Wit S, Wit F, Fontas E, Vehreschild J, Vesterbacka J, Greenberg L, Hatleberg C, Garges H, Gallant J, Volny Anne A, Öllinger A, Mozer‐Lisewska I, Surial B, Spagnuolo V, Necsoi C, van der Valk M, Mocroft A, Law M, Ryom L, Petoumenos K. Incidence of hypertension in people with HIV who are treated with integrase inhibitors versus other antiretroviral regimens in the RESPOND cohort consortium. HIV Med 2022; 23:895-910. [PMID: 35233903 PMCID: PMC9545382 DOI: 10.1111/hiv.13273] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/30/2022] [Accepted: 02/03/2022] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To compare the incidence of hypertension in people living with HIV receiving integrase strand transfer inhibitor (INSTI)-based antiretroviral therapy (ART) versus non-nucleoside reverse transcriptase inhibitors (NNRTIs) or boosted protease inhibitors (PIs) in the RESPOND consortium of HIV cohorts. METHODS Eligible people with HIV were aged ≥18 years who initiated a new three-drug ART regimen for the first time (baseline), did not have hypertension, and had at least two follow-up blood pressure (BP) measurements. Hypertension was defined as two consecutive systolic BP measurements ≥140 mmHg and/or diastolic BP ≥90 mmHg or initiation of antihypertensives. Multivariable Poisson regression was used to determine adjusted incidence rate ratios (aIRRs) of hypertension, overall and in those who were ART naïve or experienced at baseline. RESULTS Overall, 4606 people living with HIV were eligible (INSTIs 3164, NNRTIs 807, PIs 635). The median baseline systolic BP, diastolic BP, and age were 120 (interquartile range [IQR] 113-130) mmHg, 78 (70-82) mmHg, and 43 (34-50) years, respectively. Over 8380.4 person-years (median follow-up 1.5 [IQR 1.0-2.7] years), 1058 (23.0%) participants developed hypertension (incidence rate 126.2/1000 person-years, 95% confidence interval [CI] 118.9-134.1). Participants receiving INSTIs had a higher incidence of hypertension than those receiving NNRTIs (aIRR 1.76; 95% CI 1.47-2.11), whereas the incidence was no different in those receiving PIs (aIRR 1.07; 95% CI 0.89-1.29). The results were similar when the analysis was stratified by ART status at baseline. CONCLUSION Although unmeasured confounding and channelling bias cannot be excluded, INSTIs were associated with a higher incidence of hypertension than were NNRTIs, but rates were similar to those of PIs overall, in ART-naïve and ART-experienced participants within RESPOND.
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Affiliation(s)
- Dathan M. Byonanebye
- Kirby InstituteUniversity of New South WalesSydneyNew South WalesAustralia,School of Public HealthMakerere UniversityKampalaUganda
| | - Mark N. Polizzotto
- Kirby InstituteUniversity of New South WalesSydneyNew South WalesAustralia
| | - Bastian Neesgaard
- CHIPCentre of Excellence for Health, Immunity, and InfectionsRigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | - Mario Sarcletti
- Department of Dermatology, Venerology and AllergologyMedical University InnsbruckInnsbruckAustria
| | - Raimonda Matulionyte
- Department of Infectious Diseases and DermatovenerologyFaculty of MedicineVilnius University Hospital Santaros KlinikosVilnius UniversityVilniusLithuania
| | - Dominique L. Braun
- Division of Infectious Diseases and Hospital EpidemiologySwitzerland Swiss HIV Cohort Study (SHCS)Institute of Medical VirologyUniversity Hospital ZurichUniversity of ZurichZurichSwitzerland
| | - Antonella Castagna
- San Raffaele Scientific InstituteUniversità Vita‐Salute San RaffaeleMilanoItaly
| | - Stéphane de Wit
- CHU Saint PierreInfectious DiseasesUniversité Libre de BruxellesBrusselsBelgium
| | - Ferdinand Wit
- AIDS Therapy Evaluation in the Netherlands (ATHENA) CohortHIV Monitoring FoundationAmsterdamThe Netherlands
| | - Eric Fontas
- Nice HIV CohortUniversité Côte d’Azur et Centre Hospitalier UniversitaireNiceFrance
| | - Jörg Janne Vehreschild
- Medical Department 2Hematology/OncologyUniversity Hospital of FrankfurtFrankfurtGermany,Department I for Internal MedicineUniversity Hospital of CologneCologneGermany
| | - Jan Vesterbacka
- Swedish InfCare HIV CohortKarolinska University HospitalHuddingeSweden
| | - Lauren Greenberg
- Centre for Clinical ResearchEpidemiology, Modelling and Evaluation (CREME)Institute for Global HealthUniversity College LondonLondonUK
| | - Camilla Hatleberg
- CHIPCentre of Excellence for Health, Immunity, and InfectionsRigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | | | | | | | - Angela Öllinger
- CHIPCentre of Excellence for Health, Immunity, and InfectionsRigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | | | - Bernard Surial
- Department of Infectious Diseases, InselspitalBern University HospitalUniversity of BernBernSwitzerland
| | - Vincenzo Spagnuolo
- San Raffaele Scientific InstituteUniversità Vita‐Salute San RaffaeleMilanoItaly
| | - Coca Necsoi
- CHU Saint PierreInfectious DiseasesUniversité Libre de BruxellesBrusselsBelgium
| | - Marc van der Valk
- AIDS Therapy Evaluation in the Netherlands (ATHENA) CohortHIV Monitoring FoundationAmsterdamThe Netherlands,Division of Infectious DiseasesDepartment of Internal MedicineAmsterdam Institute for Infection and ImmunityAmsterdam University Medical CentersUniversity of AmsterdamAmsterdamThe Netherlands
| | - Amanda Mocroft
- CHIPCentre of Excellence for Health, Immunity, and InfectionsRigshospitaletUniversity of CopenhagenCopenhagenDenmark,Centre for Clinical ResearchEpidemiology, Modelling and Evaluation (CREME)Institute for Global HealthUniversity College LondonLondonUK
| | - Matthew Law
- Kirby InstituteUniversity of New South WalesSydneyNew South WalesAustralia
| | - Lene Ryom
- CHIPCentre of Excellence for Health, Immunity, and InfectionsRigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | - Kathy Petoumenos
- Kirby InstituteUniversity of New South WalesSydneyNew South WalesAustralia
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