Trends over time of virological and immunological characteristics in the Swiss HIV Cohort Study*

Ledergerber, Bruno; Cavassini, Matthias; Battegay, Manuel; Bernasconi, Enos; Vernazza, Pietro; Hirschel, Bernard; Furrer, Hansjakob; Rickenbach, Martin; Weber, Rainer

doi:10.1111/j.1468-1293.2010.00880.x

Cited by 20 publications

(20 citation statements)

References 17 publications

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“…Similar to a prior study of predictors of virologic suppression [5], we found treatment interruptions to be the strongest negatively correlated predictor of having an undetectable viral load. Of note, there was a considerable decrease in the proportion of patients with an ART interruption of greater than one month duration per calendar year.…”

Section: Discussionsupporting

confidence: 87%

“…We did not conduct a closed cohort analysis, however, a prior study found no difference in time trends for virologic outcomes when comparing a closed versus open cohort [5]. Our results did demonstrate a significant increase in pre-treatment CD4+ T-cell counts per calendar year for patients starting ART, which may partially account for the improving time trends in virologic and immunologic response to ART [21-24].…”

Section: Discussionmentioning

confidence: 62%

“…Given the importance of maintaining virologic suppression for reducing the risk of clinical progression of HIV and ultimately death, as well as decreasing HIV transmissibility [11], studies have analyzed the association between clinical and demographic factors and HIV-1 RNA levels to determine factors associated with virologic suppression [5,9]. Data from the Swiss HIV Cohort found treatment interruptions and poor adherence to be the most predictive factors of not maintaining virologic suppression [5].…”

Section: Introductionmentioning

confidence: 99%

“…Data from the Swiss HIV Cohort found treatment interruptions and poor adherence to be the most predictive factors of not maintaining virologic suppression [5]. In Brazil, there are published data regarding predictors of virologic response after ART initiation; however, there are limited data regarding population-level long-term response to ART [6].…”

Section: Introductionmentioning

confidence: 99%

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Improved virologic outcomes over time for HIV-infected patients on antiretroviral therapy in a cohort from Rio de Janeiro, 1997–2011

et al. 2014

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BackgroundPrevious cohort studies have demonstrated the beneficial effects of antiretroviral therapy (ART) on viral load suppression. We aimed to examine the factors associated with virologic suppression for HIV-infected patients on ART receiving care at the Evandro Chagas Clinical Research Institute, Oswaldo Cruz Foundation in Rio de Janeiro, Brazil.MethodsHIV-1 RNA levels and CD4+ T-cell counts at the date closest to midyear (1 July) were evaluated for 1,678 ART-naïve patients ≥18 years of age initiating ART between 1997 and 2010. The odds ratios (OR) and 95% confidence intervals (CI) for having an undetectable viral load (≤400 copies/mL) were estimated using generalized estimating equations regression models adjusted for clinical and demographic factors. Time-updated covariates included age, years since HIV diagnosis, hepatitis C diagnosis and ART interruptions.ResultsBetween 1997 and 2011, the proportion of patients with an undetectable viral load increased from 6% to 78% and the median [interquartile range] CD4+ T-cell count increased from 207 [162, 343] to 554 [382, 743] cells/μL. Pre-treatment median CD4+ T-cell count significantly increased over the observation period from 114 [37, 161] to 237 [76, 333] cells/μL (p < .001). The per-year adjusted OR (aOR) for having undetectable viral load was 1.18 (95% CI = 1.16-1.21). ART interruptions >1 month per calendar significantly decreased the odds [aOR = 0.32 (95% CI = 0.27-0.38)] of having an undetectable viral load. Patients initiating on a protease inhibitor (PI)-based first-line regimen were less likely to have undetectable viral load [aOR = 0.72 (95% CI = 0.63-0.83)] compared to those initiating on a non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimen.ConclusionsOur results demonstrate significant improvements in virologic outcomes from 1997 to 2011, which persisted after adjusting for other factors. This may in part be due to improvements in care and new treatment options. NNRTI- versus PI-based first-line regimens were found to be associated with increased odds of having an undetectable viral load, consistent with previous studies. Treatment interruptions were found to be the most important determinant of not having an undetectable viral load. Studies are needed to characterize the reasons for treatment interruptions and to develop subsequent strategies for improving adherence to ART.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 62%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Improved virologic outcomes over time for HIV-infected patients on antiretroviral therapy in a cohort from Rio de Janeiro, 1997–2011

et al. 2014

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“…COMBINED ANTIRETROVIRAL (ARV) THERAPY (ART), resulting in undetectable plasma HIV, has drastically amended HIVrelated morbidity and mortality in patients, while essentially abrogating the mucosal transmission of the AIDS virus to the uninfected partner (2,3). Yet, under effective ART or highly active ARV treatment (HAART), HIV persists as proviral DNA, forming a latent reservoir within resting memory CD4 + T cells ever since the time of primary HIV infections (4-6), recalcitrant to current antiviral therapy.…”

mentioning

confidence: 99%

Four days a week or less on appropriate anti‐HIV drug combinations provided long‐term optimal maintenance in 94 patients: the ICCARRE project

et al. 2015

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Short, intraweekly cycles of anti‐HIV combinations have provided intermittent, effective therapy (on 48 patients) (1). The concept is now extended to 94 patients on treatment, 4 days per week or less, over a median of 2.7 discontinuous treatment years per patient. On suppressive combinations, 94 patients volunteered to treatment, 5 and 4 days per week, or reduced stepwise to 4,3,2, and 1 days per week in 94, 84, 66, and 12 patients, respectively, on various triple, standard, antiviral combinations, or nonregistered, quadruple, antiviral combinations. Ninety‐four patients on treatment 4 days per week aggregated 165 intermittent treatment years; no viral breakthrough was observed over 87 average treatment weeks per patient, 63 of 94 having passed 2.5 intermittent treatment years on any of the antiviral combinations prescribed. On the hyperintermittent treatment of 3, 2, and 1 days per week, HIV RNA surged >50 copies, 4 weeks apart, in 18 instances (6.8 viral escapes/100 hyperdiscontinuous maintenance years). Viral escapes could have been a result of erratic adherence (EA) to regimen or follow‐up (3 patients)—drug taken at half of the daily recommended dosage (8 patients) and/or overlooked archival‐resistant HIVs from antecedent treatment failures (6 patients). Aside from the above circumstances, HIV unexpectedly rebounded in 3 patients on 2 days per week treatment and 1 patient on 1 day per week treatment, posting 2.2 intrinsic viral escapes/100 highly discontinuous treatment years. All 18 escapes were eventually reversed by 7 days per week salvage combinations, and 11 of 18 patients have been back for a second course of intermittent therapy, 4 days per week or less. Both cell‐activation markers on the surface of T lymphocytes and cell‐bound HIV DNA levels remained stable or declined. CD4/CD8 ratios rose to ≤1 in 35% of patients, whereas CD4 counts went ≤500/μl in 75%. These values were previously 7 and 40%, respectively, on 7 days per week therapy. In our aging, long, HIV‐enduring, multitreated patient cohort, treatment 4 days per week and less over 421 intermittent treatment years reduced prescription medicines by 60%—equivalent to 3 drug‐free/3 virus‐free remission year per patient—actually sparing €3 million on just 94 patients at the cost of 2.2 intrinsic viral failure/100 hyperintermittent treatment years. At no risk of viral escape, maintenance therapy, 4 days per week, would quasiuniversally offer 40% cuts off of current overprescriptions.—Leibowitch, J., Mathez, D., de Truchis, P., Ledu, D., Melchior, J. C., Carcelain, G., Izopet, J., Perronne, C., David, J. R. Four days a week or less on appropriate anti‐HIV drug combinations provided long‐term optimal maintenance in 94 patients: the ICCARRE project. FASEB J. 29, 2223‐2234 (2015). http://www.fasebj.org

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Incidence and Types of Human Papillomavirus Infections in Adolescent Girls and Young Women Immunized With the Human Papillomavirus Vaccine

et al. 2021

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Key Points Question Has the introduction of the vaccine for human papillomavirus (HPV) been associated with changes in infection rates among sexually active adolescent girls and young adult women? Findings This cohort study assessed HPV infection rates of vaccinated adolescent and young adult women at a large adolescent-specific health center in New York City. Age-adjusted cervical HPV detection of vaccine-related types were lower year over year, while the prevalence of nonvaccine high-risk HPV types remained flat or higher. Meaning These results indicate the real-world effectiveness of the HPV vaccines in female youth in New York City; nevertheless, rates of some nonvaccine high-risk HPV types were higher.

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Trends over time of virological and immunological characteristics in the Swiss HIV Cohort Study*

Cited by 20 publications

References 17 publications

Improved virologic outcomes over time for HIV-infected patients on antiretroviral therapy in a cohort from Rio de Janeiro, 1997–2011

Improved virologic outcomes over time for HIV-infected patients on antiretroviral therapy in a cohort from Rio de Janeiro, 1997–2011

Four days a week or less on appropriate anti‐HIV drug combinations provided long‐term optimal maintenance in 94 patients: the ICCARRE project

Incidence and Types of Human Papillomavirus Infections in Adolescent Girls and Young Women Immunized With the Human Papillomavirus Vaccine

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