Mortality and immunovirological outcomes in patients with advanced HIV disease on their first antiretroviral treatment: differential impact of antiretroviral regimens

Burgos, Joaquín; Moreno-Fornés, Sergio; Reyes-Urueña, Juliana; Bruguera, Andreu; Martín-Iguacel, Raquel; Raventós, Berta; Llibre, Josep M; Imaz, Arkaitz; Peraire, Joaquim; Orti, Amat-Joaquim; Dalmau, David; Casabona, Jordi; Miró, Josep M.; Falcó, Vicenç; Muntada, Esteve; Esteve, Anna; Fanjul, Francisco; Knobel, Hernando; Mallolas, Josép; Tiraboschi, Juan; Curran, Adrían; Revollo, Boris; Gracia, María Pilar Rivero; Gutierrez, María del Mar; Murillas, Javier; Homar, Francisco Bujosa; Fernández-Montero, José Vicente; González, Eva López; Force, Lluís; León, Elena; Hortos, Miquel; Vilaró, Ingrid; Ortí, Amat; Jaén, Àngels; Lazzari, Elisa de; Berrocal, Leire; Rodríguez, Lucía; Gargoulas, Freya; Vanrell, Toni; Carlos, José; Vilà, Josep; Martinez, Marina; Morell, Bibiana; Tamayo, Maribel; Palacio, Jorge; Ambrosioni, Juan; Laguno, Montse; Martı́nez-Rebollar, Marı́a; Blanco, José Luis Santiago; García, Felipe Andreo; Torres, Berta; Mora, Lorena de la; Inciarte, Alexy; Ugarte, Ainoa; Chivite, Iván; González-Cordón, Ana; Leal, Lorna; Jou, Antoni; Negredo, Eugènia; Saumoy, María; Silva, Ana; Scévola, Sofía; Suanzes, Paula; Álvarez, Patricia; Mur, Isabel; Jaume, Melchor Riera; García-Gasalla, Mercedes; Ribas, Maria Àngels; Campins, Antoni A; Peñaranda, María; Martín, María Luisa; Haydee, Helem; Calzado, Sònia; Cervantes, Manel; Navarro, M. Ortin; Payeras, Antoni; Cifuentes, Carmen; Villoslada, Aroa; Sorní, Patrícia; Molero, Marta; Abdulghani, Nadia; Comella, Thaïs; Sola, Rocio; Vargas, Montserrat; Viladés, Consuleo; Martí, Anna; Yeregui, Elena; Rull, Anna; Barrufet, Pilar; Arbones, Laia; Chamarro, Elena; Escrig, Cristina; Cairó, Mireia; Martínez-Lacasa, Xavier; Font, Roser; Macorigh, Lizza; Hernández, Juanse

doi:10.1093/jac/dkac361

Cited by 7 publications

(4 citation statements)

References 21 publications

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“…Previous ndings [33][34][35] indicate older age may be a risk factor for incomplete CD4 + T cell recovery in PLWH, suggesting age may exert a strong effect on long-term recovery of CD4 + T cells. This was also found in the newly developed model, showing that median maximal CD4 + T cell count is higher in patients aged 16-32.5 years than in patients aged 32.5 years after ART treatment.…”

Section: Resultsmentioning

confidence: 93%

Incomplete immune reconstitution and its predictors in people living with HIV in Wuhan, China

Zhang

Yan

Luo

et al. 2023

Preprint

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Objective This study aimed to build and validate a nomogram model to predict the risk of incomplete immune reconstitution in people living with HIV (PLWH).Methods Totally 3783 individuals with a confirmed diagnosis of HIV/AIDS were included. A predictive model was developed based on a retrospective set (N = 2678) and was validated using the remaining cases (N = 1105). Univariable and multivariable logistic regression analyses were performed to determine valuable predictors among the collected clinical and laboratory variables. The predictive model was presented as a nomogram, and internally validated using another independent dataset. The predictive value of the model was evaluated by determining the area under the curve (AUC). Besides, calibration curve and decision curve (DCA) analyses were performed in both the training and test sets.Results The final model comprised 5 predictors, including baseline CD4, age at ART initiation, BMI, HZ and TBIL. The AUC of the nomogram model was 0.902 in the training cohort, versus 0.926 in the validation cohort. The calibration accuracy and diagnostic performance were satisfactory in both the training and test sets.Conclusions This predictive model based on a retrospective study was internally validated using 5 readily available clinical indicators. It showed high performance in predicting the risk of incomplete immune reconstitution.

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Section: Resultsmentioning

confidence: 93%

Incomplete immune reconstitution and its predictors in people living with HIV in Wuhan, China

Zhang

Yan

Luo

et al. 2023

Preprint

View full text Add to dashboard Cite

show abstract

“…Previous findings [ 32 , 36 , 37 ] indicate older age may be a risk factor for incomplete CD4 + T cell recovery in PLWH, suggesting age may exert a strong effect on long-term recovery of CD4 + T cells. This was also found in the newly developed model, showing that median maximal CD4 + T cell count is higher in patients aged 16–32.5 years than in patients aged 32.5 years after ART treatment.…”

Section: Discussionmentioning

confidence: 99%

Incomplete immune reconstitution and its predictors in people living with HIV in Wuhan, China

Zhang,

Yan,

Luo

et al. 2023

BMC Public Health

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Objective This study aimed to build and validate a nomogram model to predict the risk of incomplete immune reconstitution in people living with HIV (PLWH). Methods Totally 3783 individuals with a confirmed diagnosis of HIV/AIDS were included. A predictive model was developed based on a retrospective set (N = 2678) and was validated using the remaining cases (N = 1105). Univariate and multivariate logistic regression analyses were performed to determine valuable predictors among the collected clinical and laboratory variables. The predictive model is presented in the form of a nomogram, which is internally and externally validated with two independent datasets. The discrimination of nomograms was assessed by calculating the area under the curve (AUC). Besides, calibration curve and decision curve (DCA) analyses were performed in the training and validation sets. Results The final model comprised 5 predictors, including baseline CD4, age at ART initiation, BMI, HZ and TBIL. The AUC of the nomogram model was 0.902, 0.926, 0.851 in the training cohort, internal validation and external cohorts. The calibration accuracy and diagnostic performance were satisfactory in both the training and validation sets. Conclusions This predictive model based on a retrospective study was externally validated using 5 readily available clinical indicators. It showed high performance in predicting the risk of incomplete immune reconstitution in people living with HIV.

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“…In a multicentre European observational study, no difference in median CD4 cell count or CD4:CD8 ratio was observed 48 weeks after ART initiation with an INSTI or a PI among people with advanced HIV [4]. In the PISCIS cohort in Spain, people with advanced HIV were less likely to die and experienced faster virological suppression and CD4 cell count restoration when initiating ART with an INSTI than with a PI or non‐nucleoside reverse transcriptase inhibitors [5]. Similarly, among late‐presenting people with HIV (defined as CD4 <350 cells/μL or as either CD4 <350 cells/μL or ADE) in two Spanish cohorts, those initiating ART with an INSTI experienced favourable immunological outcomes compared with those initiating ART with other anchor agents [28, 32].…”

Section: Discussionmentioning

confidence: 99%

“…In the USA, the prevalence of advanced HIV was estimated at 22% in 2015; the prevalence increases with older age (up to 37% among individuals aged ≥55 years) and by transmission category (34% among men with infection attributed to heterosexual contact; 29% among men with infection attributed to injection drug use) [3]. Individuals presenting with advanced HIV infection have an increased risk of HIV clinical progression, morbidity, and mortality [4][5][6][7][8][9]. In addition, advanced HIV is associated with an increased risk of HIV transmission, due to both higher viral loads and a longer period with unsuppressed viremia [6].…”

Section: Introductionmentioning

confidence: 99%

Immune response to ART initiation in advanced HIV infection

Mounzer

Brunet²,

Fusco³

et al. 2023

HIV Medicine

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Objectives Our objective was to compare the immunological responses to commonly used antiretroviral therapy (ART) regimens among people with advanced HIV in the USA and to assess virological outcomes and regimen persistence. Methods This study included ART‐naïve adults with advanced HIV infection (CD4 cell count <200 cells/μL) initiating ART with bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF), boosted darunavir (bDRV), dolutegravir (DTG), or elvitegravir (EVG/c)‐containing regimens between 1 January 2018 and 31 December 2020 in the Observational Pharmaco‐Epidemiology Research and Analysis (OPERA) cohort. Cox proportional hazards models and linear mixed models with random intercept were fit with inverse probability of treatment weighting. Results Overall, 1349 people with advanced HIV (816 B/F/TAF, 253 DTG, 146 EVG/c, 134 bDRV) were followed for a median of 22 months. Compared with B/F/TAF, a lower likelihood of achieving a CD4 cell count ≥200 cells/μL was observed with bDRV (hazard ratio [HR] 0.76; 95% confidence interval [CI] 0.60–0.96), DTG (HR 0.82; 95% CI 0.69–0.98), and EVG/c (HR 0.73; 95% CI 0.57–0.93). All groups had a similar pattern of CD4:CD8 ratio changes: a rapid increase in the first 6 months (ranging from +0.15 to +0.16 units), followed by a slower increase thereafter. Only 40 individuals (4%) achieved CD4:CD8 ratio normalization (≥1). B/F/TAF was associated with a faster time to virological suppression (viral load <200 copies/mL) and a slower time to discontinuation compared with other regimens. Conclusions Among people with advanced HIV infection, B/F/TAF initiation was associated with faster CD4 cell count recovery and favourable virological outcomes compared with bDRV‐, DTG‐, and EVG/c‐based regimens, although no difference was observed in CD4:CD8 ratio changes over time across regimens.

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Mortality and immunovirological outcomes in patients with advanced HIV disease on their first antiretroviral treatment: differential impact of antiretroviral regimens

Cited by 7 publications

References 21 publications

Incomplete immune reconstitution and its predictors in people living with HIV in Wuhan, China

Incomplete immune reconstitution and its predictors in people living with HIV in Wuhan, China

Incomplete immune reconstitution and its predictors in people living with HIV in Wuhan, China

Immune response to ART initiation in advanced HIV infection

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