Category of exposure to HIV and age in the progression to AIDS: longitudinal study of 1199 people with known dates of seroconversion

Pezzotti, Patrizio; Phillips, Andrew; Dorrucci, Maria; Lepri, Alessandro Cozzi; Galai, Noya; Vlahov, David; Rezza, Giovanni

doi:10.1136/bmj.313.7057.583

Cited by 98 publications

(49 citation statements)

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“…This finding may be explained by the fact that older patients tend to be more adherent and therefore they may experience better virological responses, but also, for a given VL, older patients are less likely to show a recovery in CD4 cell count because of possible reductions in thymic function and the production of naïve T cells [25].…”

Section: Discussionmentioning

confidence: 78%

Favourable evolution of virological and immunological profiles in treated and untreated patients in Italy in the period 1998-2008

et al. 2010

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BackgroundThis study provides an estimate of the proportion of HIV-positive patients in Italian clinics showing an 'adverse prognosis' (defined as a CD4 count 200 cells/mL or an HIV RNA 450 HIV-1 RNA copies/mL) over time, and investigates whether this proportion varied according to patients' characteristics. MethodsWe estimated the annual proportion of patients with a CD4 count 200 cells/mL or HIV RNA 450 copies/mL out of the total number of patients in the Icona Foundation cohort seen in any given year, both overall and after stratifying by demographical and treatment status groups. Generalized estimating equation models for Poisson regression were applied. ResultsIn 1998-2008, the prevalence of patients with a CD4 count 200 cells/mL decreased from 14 to 6% [adjusted relative risk (RR) 0.86/year; 95% confidence interval (CI) 0.84-0.88; Po0.0001]. The prevalence of HIV RNA 450 copies/mL decreased from 66 to 40% (adjusted RR 0.95/year; 95% CI 0.95-0.96; Po0.0001) in all patients and from 38 to 12% in the subgroup of patients who had previously received antiretroviral therapy (ART) for 6 months (adjusted RR 0.89/year; 95% CI 0.88-0.90; Po0.0001). ConclusionsThere was a substantial increase in the success rate of ART in Italy in 1998, resulting in a lower percentage of patients with adverse prognosis in recent years. The use of ART seemed to be the most important determinant of viral load outcome, regardless of mode of transmission. Although injecting drug users showed a less marked improvement in CD4 cell count over time than other risk groups, they showed a similar improvement in detectable viral load. IntroductionIn the decade (1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008) since the introduction of combination antiretroviral therapy (cART), the rates of AIDS-related deaths and pathological events have dramatically decreased in Western Europe [1]. The declining trends over time in the prevalence of immunosuppression Correspondence: Dr Mattia C. F. Prosperi, Clinic of Infectious Diseases, Catholic University of the Sacred Heart, Largo F. Vito, 1, 00146 Rome, Italy. Tel: 1 39 338 259 6115; e-mail: ahnven@yahoo.it *See Appendix. DOI: 10.1111/j.1468-1293.2010.00866.x HIV Medicine (2011 r 2010 British HIV Association 174 and detectable viraemia [2,3] reflect the impact of the successful use of cART, together with increases in drug uptake [4]. The best predictor of disease progression is the current absolute CD4 cell count, but the patient's age, current HIV RNA viral load (VL) and pre-ART AIDS diagnoses have also been shown to play a significant role in disease progression [5,6]. Populations of HIV-infected individuals are composed of subgroups with different demographics, and it remains unclear whether virological outcomes vary according to patients' mode of HIV acquisition, possibly because of differences in the level of adherence to ART [7]. In addition, different ethnic groups may have different opportunities to access medical care [8]. Other factors, such as hepatitis coinfections and centre...

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Section: Discussionmentioning

confidence: 78%

Favourable evolution of virological and immunological profiles in treated and untreated patients in Italy in the period 1998-2008

et al. 2010

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“…Our results show that the proportion of persons with a short interval is larger in the border region than elsewhere in the United States (CDC, 2008a). Among males, the number with a short interval increased with age, which may be explained by the fact that HIV disease tends to progress more rapidly among older persons (Pezzotti et al, 1996). Another possible explanation is that older persons are assumed not to be at risk and therefore are not the focus of testing programs.…”

Section: Discussionmentioning

confidence: 99%

Increases in HIV Diagnoses at the U.S.–Mexico Border, 2003–2006

Espinoza

Hall

2009

AIDS Education and Prevention

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Section: Discussionmentioning

confidence: 99%

“…In our study, patients over 50 years old lost the recovered CD4 cells in a median of 7.9 months, while patients under 35 years old returned to their nadir count in double the time (Table 3). Age at infection was one of the most widely recognized risk factors for progression to AIDS in the pre-ART era [22][23][24][25].Pre-ART HIV RNA levels were not available for almost a third of the patients in the study cohort. Using estimates of the missing data, as described in the statistical analysis section, we found that patients with higher HIV RNA levels lost the CD4 cells recovered during therapy more quickly.…”

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confidence: 99%

Factors predicting the time for CD4 T‐cell count to return to nadir in the course of CD4‐guided therapy interruption in chronic HIV infection^*

et al. 2008

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ObjectiveOur previous studies on CD4-guided therapy interruption (TI) showed that the durations of the first and second TIs were similar if antiretroviral therapy (ART) was resumed at a level of the CD4 cell count similar to or higher than the nadir CD4 T-cell count. Therefore, in a strategy of repeated CD4-guided TI, it is important to know which factors predict the time for the CD4 T-cell count to return to nadir (TRN). MethodsFrom a cohort of 125 patients who interrupted ART, 92 patients who reached a CD4 T-cell count similar to the nadir count were included in the study. ResultsThe median TRN was 12.3 months. In the multivariate analysis, younger age (P 5 0.011), lower pre-ART HIV RNA (P 5 0.022) and female gender (P 5 0.045) were associated with a longer TRN. After TI there were 11 clinical events in the group of patients whose nadir CD4 count was 4200 cells/mL. Most of these events occurred when the TI was prolonged beyond the TRN. ConclusionsThe factors predicting the TRN were age, HIV RNA pre-ART and gender. Resumption of therapy at a CD4 cell count similar to the nadir CD4 count appears to protect against the development of clinical events. Given the observational nature of this study, no conclusions can be drawn regarding the possible application of TI in clinical practice.Keywords: age, antiretroviral therapy, CD4 lymphocyte count, sex Received: 31 May 2007, accepted 9 October 2007 Introduction At present, HIV infection cannot be eradicated and its control requires life-long treatment with antiretroviral therapy (ART).The need to find a balance between the efficacy and toxicity of ART has led to numerous studies evaluating the possible use of strategies based on therapy interruptions (TIs) guided by the number of CD4 lymphocytes. Recent randomised trials comparing a strategy of TI guided by CD4 cell counts and continuous treatment have produced discordant results.In both the SMART [1] and TRIVACAN [2] trials, the patients managed with CD4-guided TI had a higher risk of disease progression or death compared with those managed with continuous therapy. In contrast, in the STACCATO [3], BASTA [4] and TIBET [5] trials the results of the two strategies were equivalent in terms of clinical events.The results of SMART, the study on TI that has enrolled the largest number of patients, profoundly altered the recommendations of the Department of Health and Human Services (DHHS) concerning CD4-guided TI, which was previously indicated as a possibility to offer to patients with immune reconstitution (October 2005) [6] and is now stated to be an approach that should be avoided in clinical practice (May 2006) 19In the SMART study [1], the risk of clinical events was independent of the nadir CD4 cell count and always higher in the ''drug conservation'' arm. The risk was also higher in patients who were not taking any medication at the time of enrolment, suggesting that at least part of the increased risk was not dependent on the TI but rather on the criteria for resuming treatment. There is, in fact, no doubt that...

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Category of exposure to HIV and age in the progression to AIDS: longitudinal study of 1199 people with known dates of seroconversion

Cited by 98 publications

References 28 publications

Favourable evolution of virological and immunological profiles in treated and untreated patients in Italy in the period 1998-2008

Favourable evolution of virological and immunological profiles in treated and untreated patients in Italy in the period 1998-2008

Increases in HIV Diagnoses at the U.S.–Mexico Border, 2003–2006

Factors predicting the time for CD4 T‐cell count to return to nadir in the course of CD4‐guided therapy interruption in chronic HIV infection^*

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Category of exposure to HIV and age in the progression to AIDS: longitudinal study of 1199 people with known dates of seroconversion

Cited by 98 publications

References 28 publications

Favourable evolution of virological and immunological profiles in treated and untreated patients in Italy in the period 1998-2008

Favourable evolution of virological and immunological profiles in treated and untreated patients in Italy in the period 1998-2008

Increases in HIV Diagnoses at the U.S.–Mexico Border, 2003–2006

Factors predicting the time for CD4 T‐cell count to return to nadir in the course of CD4‐guided therapy interruption in chronic HIV infection*

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Factors predicting the time for CD4 T‐cell count to return to nadir in the course of CD4‐guided therapy interruption in chronic HIV infection^*