Mortality and immunovirological outcomes in patients with advanced HIV disease on their first antiretroviral treatment: differential impact of antiretroviral regimens.
J Antimicrob Chemother
; 78(1): 108-116, 2022 12 23.
Article
em En
| MEDLINE
| ID: mdl-36308326
ABSTRACT
OBJECTIVES:
To assess the clinical and immunovirological outcomes among naive patients with advanced HIV presentation starting an antiretroviral regimen in real-life settings.METHODS:
This was a multicentre, prospective cohort study. We included all treatment-naive adults with advanced HIV disease (CD4+ T cell countâ<â200â cells/mm3or presence of an AIDS-defining illness) who started therapy between 2010 and 2020. The main outcomes were mortality, virological effectiveness (percentage of patients with viral load of ≤50â copies/mL) and immune restoration (percentage of patients with CD4+ T cell count above 350â cells/mm3). Competing risk analysis and Cox proportional models were performed. A propensity score-matching procedure was applied to assess the impact of the antiretroviral regimen.RESULTS:
We included 1594 patients with advanced HIV disease [median CD4+T cell count of 81â cells/mm3and 371 (23.3%) with AIDS-defining illness] and with a median follow-up of 4.44â years. The most common ART used was an integrase strand transfer inhibitor (InSTI) regimen (46.9%), followed by PI (35.7%) and NNRTI (17.4%), with adjusted mortality rates at 3â years of 3.1% (95% CI 1.8%-4.3%), 4.7% (95% CI 2.2%-7.1%) and 7.6% (95% CI 5.4%-9.7%) (Pâ=â0.001), respectively. Factors associated with increased mortality included older age and history of injection drug use, whilst treatment with an InSTI regimen was a protective factor [HR 0.5 (95% CI 0.3-0.9)]. A sensitivity analysis with propensity score procedure confirms these results. Patients who started an InSTI achieved viral suppression and CD4+ T cell count above 350â cells/mm3significantly earlier.CONCLUSIONS:
In this large real-life prospective cohort study, a significant lower mortality, earlier viral suppression and earlier immune reconstitution were observed among patients with advanced HIV disease treated with InSTIs.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Infecções por HIV
/
Síndrome da Imunodeficiência Adquirida
/
Inibidores da Protease de HIV
/
Fármacos Anti-HIV
Tipo de estudo:
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Adult
/
Humans
Idioma:
En
Revista:
J Antimicrob Chemother
Ano de publicação:
2022
Tipo de documento:
Article
País de afiliação:
Espanha