Persistent poor clinical outcomes of people living with HIV presenting with AIDS and late HIV diagnosis - results from the ICONA cohort in Italy, 2009-2022
Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved..
OBJECTIVES: Limited data are available on the long-term outcomes in recent years for late HIV diagnosis (LD).
METHODS: All subjects with HIV enrolled in the ICONA cohort in 2009-2022 who started antiretroviral treatment (ART) within 4 months from diagnosis were included and divided into: (i) pre-ART CD4 count ≥350/mm3 without AIDS (non-LD), (ii) pre-ART CD4 count <350/mm3 without AIDS (LD asymptomatic), and (iii) with AIDS events pre-ART (LD-AIDS). The estimated probability and independent risk for mortality (all-cause and cause-specific) and treatment failure were evaluated.
RESULTS: Of 6813 participants (2448 non-LD, 3198 LD asymptomatic, and 1167 LD-AIDS), 161 (2.4%) died after ART initiation. At survival analysis, a higher probability of all-cause mortality has been identified for LD than non-LD (P <0.001) and within the former, for LD-AIDS over LD asymptomatic (P <0.001). After adjusting for confounders, LD showed a higher risk of all-cause mortality (vs non-LD adjusted hazard ratio (aHR) 5.51, P <0.001) and, in particular, being an AIDS presenter predicted a greater risk of all-cause (aHR = 4.42, P <0.001), AIDS-related (adjusted subhazard ratio [aSHR] = 16.86, P <0.001), and non-AIDS-related mortality (aSHR = 1.74, P = 0.022) than the rest of the late presenters. Among the short-term survivors in the LD-AIDS group, the long-term mortality was mediated by the lack of immune recovery at 2 years. Finally, LD compared with non-LD and, particularly, among the former, LD-AIDS over LD asymptomatic showed a greater risk of treatment failure.
CONCLUSIONS: In recent years, LD subjects, particularly, AIDS presenters, remained at a higher risk of poorer outcomes. Public health strategies for early HIV diagnosis are urgently needed to constrain the mortality gap.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:142 |
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| Enthalten in: |
International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases - 142(2024) vom: 15. Apr., Seite 106995 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Mondi, Annalisa [VerfasserIn] |
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| Links: |
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| Themen: |
AIDS |
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| Anmerkungen: |
Date Completed 16.04.2024 Date Revised 16.04.2024 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.ijid.2024.106995 |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM369481542 |
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| 100 | 1 | |a Mondi, Annalisa |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Persistent poor clinical outcomes of people living with HIV presenting with AIDS and late HIV diagnosis - results from the ICONA cohort in Italy, 2009-2022 |
| 264 | 1 | |c 2024 | |
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| 500 | |a Date Completed 16.04.2024 | ||
| 500 | |a Date Revised 16.04.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved. | ||
| 520 | |a OBJECTIVES: Limited data are available on the long-term outcomes in recent years for late HIV diagnosis (LD) | ||
| 520 | |a METHODS: All subjects with HIV enrolled in the ICONA cohort in 2009-2022 who started antiretroviral treatment (ART) within 4 months from diagnosis were included and divided into: (i) pre-ART CD4 count ≥350/mm3 without AIDS (non-LD), (ii) pre-ART CD4 count <350/mm3 without AIDS (LD asymptomatic), and (iii) with AIDS events pre-ART (LD-AIDS). The estimated probability and independent risk for mortality (all-cause and cause-specific) and treatment failure were evaluated | ||
| 520 | |a RESULTS: Of 6813 participants (2448 non-LD, 3198 LD asymptomatic, and 1167 LD-AIDS), 161 (2.4%) died after ART initiation. At survival analysis, a higher probability of all-cause mortality has been identified for LD than non-LD (P <0.001) and within the former, for LD-AIDS over LD asymptomatic (P <0.001). After adjusting for confounders, LD showed a higher risk of all-cause mortality (vs non-LD adjusted hazard ratio (aHR) 5.51, P <0.001) and, in particular, being an AIDS presenter predicted a greater risk of all-cause (aHR = 4.42, P <0.001), AIDS-related (adjusted subhazard ratio [aSHR] = 16.86, P <0.001), and non-AIDS-related mortality (aSHR = 1.74, P = 0.022) than the rest of the late presenters. Among the short-term survivors in the LD-AIDS group, the long-term mortality was mediated by the lack of immune recovery at 2 years. Finally, LD compared with non-LD and, particularly, among the former, LD-AIDS over LD asymptomatic showed a greater risk of treatment failure | ||
| 520 | |a CONCLUSIONS: In recent years, LD subjects, particularly, AIDS presenters, remained at a higher risk of poorer outcomes. Public health strategies for early HIV diagnosis are urgently needed to constrain the mortality gap | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a AIDS | |
| 650 | 4 | |a HIV | |
| 650 | 4 | |a Immune recovery | |
| 650 | 4 | |a Late presenters | |
| 650 | 4 | |a Mortality | |
| 650 | 7 | |a Anti-Retroviral Agents |2 NLM | |
| 650 | 7 | |a Anti-HIV Agents |2 NLM | |
| 700 | 1 | |a Cozzi-Lepri, Alessandro |e verfasserin |4 aut | |
| 700 | 1 | |a Tavelli, Alessandro |e verfasserin |4 aut | |
| 700 | 1 | |a Cingolani, Antonella |e verfasserin |4 aut | |
| 700 | 1 | |a Giacomelli, Andrea |e verfasserin |4 aut | |
| 700 | 1 | |a Orofino, Giancarlo |e verfasserin |4 aut | |
| 700 | 1 | |a De Girolamo, Gabriella |e verfasserin |4 aut | |
| 700 | 1 | |a Pinnetti, Carmela |e verfasserin |4 aut | |
| 700 | 1 | |a Gori, Andrea |e verfasserin |4 aut | |
| 700 | 1 | |a Saracino, Annalisa |e verfasserin |4 aut | |
| 700 | 1 | |a Bandera, Alessandra |e verfasserin |4 aut | |
| 700 | 1 | |a Marchetti, Giulia |e verfasserin |4 aut | |
| 700 | 1 | |a Girardi, Enrico |e verfasserin |4 aut | |
| 700 | 1 | |a Mussini, Cristina |e verfasserin |4 aut | |
| 700 | 1 | |a d'Arminio Monforte, Antonella |e verfasserin |4 aut | |
| 700 | 1 | |a Antinori, Andrea |e verfasserin |4 aut | |
| 700 | 0 | |a ICONA Foundation Study Group |e verfasserin |4 aut | |
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