Bibliographic Details
| Title: |
Determinants of long-term survival in late HIV presenters: The prospective PISCIS cohort study |
| Authors: |
Raquel Martin-Iguacel, Juliana Reyes-Urueña, Andreu Bruguera, Jordi Aceitón, Yesika Díaz, Sergio Moreno-Fornés, Pere Domingo, Joaquín Burgos-Cibrian, Juan Manuel Tiraboschi, Isik Somuncu Johansen, Hortensia Álvarez, Josep M Miró, Jordi Casabona, Josep M Llibre |
| Source: |
EClinicalMedicine, Vol 52, Iss , Pp 101600- (2022) |
| Publisher Information: |
Elsevier, 2022. |
| Publication Year: |
2022 |
| Collection: |
LCC:Medicine (General) |
| Subject Terms: |
HIV, Late presenters, Delayed HIV diagnosis, Immune recovery, Immune response, Integrase inhibitors, Medicine (General), R5-920 |
| More Details: |
Summary: 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 CD4500 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 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. |
| Document Type: |
article |
| File Description: |
electronic resource |
| Language: |
English |
| ISSN: |
2589-5370 |
| Relation: |
http://www.sciencedirect.com/science/article/pii/S2589537022003303; https://doaj.org/toc/2589-5370 |
| DOI: |
10.1016/j.eclinm.2022.101600 |
| Access URL: |
https://doaj.org/article/ed8c4ba604b744faad9e0c66a8527d31 |
| Accession Number: |
edsdoj.8c4ba604b744faad9e0c66a8527d31 |
| Database: |
Directory of Open Access Journals |
