Determinants of long-term survival in late HIV presenters : The prospective PISCIS cohort study
© 2022 The Authors..
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.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2022 |
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| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:52 |
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| Enthalten in: |
EClinicalMedicine - 52(2022) vom: 01. Okt., Seite 101600 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Martin-Iguacel, Raquel [VerfasserIn] |
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| Links: |
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| Themen: |
Delayed HIV diagnosis |
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| Anmerkungen: |
Date Revised 16.09.2023 published: Electronic-eCollection Citation Status PubMed-not-MEDLINE |
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| doi: |
10.1016/j.eclinm.2022.101600 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM344773159 |
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| 100 | 1 | |a Martin-Iguacel, Raquel |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Determinants of long-term survival in late HIV presenters |b The prospective PISCIS cohort study |
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| 500 | |a Date Revised 16.09.2023 | ||
| 500 | |a published: Electronic-eCollection | ||
| 500 | |a Citation Status PubMed-not-MEDLINE | ||
| 520 | |a © 2022 The Authors. | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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]) | ||
| 520 | |a 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 | ||
| 520 | |a Funding: Southern-Denmark University, Danish AIDS-foundation, and Region of Southern Denmark | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Delayed HIV diagnosis | |
| 650 | 4 | |a HIV | |
| 650 | 4 | |a Immune recovery | |
| 650 | 4 | |a Immune response | |
| 650 | 4 | |a Integrase inhibitors | |
| 650 | 4 | |a Late presenters | |
| 650 | 4 | |a Mortality | |
| 700 | 1 | |a Reyes-Urueña, Juliana |e verfasserin |4 aut | |
| 700 | 1 | |a Bruguera, Andreu |e verfasserin |4 aut | |
| 700 | 1 | |a Aceitón, Jordi |e verfasserin |4 aut | |
| 700 | 1 | |a Díaz, Yesika |e verfasserin |4 aut | |
| 700 | 1 | |a Moreno-Fornés, Sergio |e verfasserin |4 aut | |
| 700 | 1 | |a Domingo, Pere |e verfasserin |4 aut | |
| 700 | 1 | |a Burgos-Cibrian, Joaquín |e verfasserin |4 aut | |
| 700 | 1 | |a Tiraboschi, Juan Manuel |e verfasserin |4 aut | |
| 700 | 1 | |a Johansen, Isik Somuncu |e verfasserin |4 aut | |
| 700 | 1 | |a Álvarez, Hortensia |e verfasserin |4 aut | |
| 700 | 1 | |a Miró, Josep M |e verfasserin |4 aut | |
| 700 | 1 | |a Casabona, Jordi |e verfasserin |4 aut | |
| 700 | 1 | |a Llibre, Josep M |e verfasserin |4 aut | |
| 700 | 0 | |a PISCIS study group |e verfasserin |4 aut | |
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