Burden of Disease in PWH Harboring a Multidrug-Resistant Virus: Data From the PRESTIGIO Registry.

Autor: Galli L; Clinic of Infectious Diseases, IRCCS San Raffaele, Milan, Italy., Parisi MR; Clinic of Infectious Diseases, IRCCS San Raffaele, Milan, Italy., Poli A; Clinic of Infectious Diseases, IRCCS San Raffaele, Milan, Italy., Menozzi M; Malattie Infettive, Policlinico di Modena, Modena, Italy., Fiscon M; UOS Malattie Infettive dell'Azienda Scaligera di Verona, Verona, Italy., Garlassi E; Malattie Infettive Arcispedale S. Maria Nuova-IRCSS, Reggio Emilia, Italy., Francisci D; Clinica di Malattie Infettive, Università degli Studi di Perugia, Perugia, Italy., Di Biagio A; Infectious Diseases Clinic, Department of Health Sciences, University of Genoa, San Martino Hospital-IRCCS, Genoa, Italy., Sterrantino G; Dipartimento di Medicina Clinica e Sperimentale, Università degli Studi di Firenze, Firenze, Italy., Fornabaio C; ASST Cremona, Cremona, Italy., Degli Antoni A; Malattie Infettive ed Epatologia, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy., Angarano G; Università degli Studi di Bari 'Aldo Moro,' Malattie Infettive, Policlinico, Bari, Italy., Fusco FM; Ospedale Santa Maria Annunziata, Bagno a Ripoli, Firenze, Italy., D'Arminio Monforte A; Clinic of Infectious Diseases, Department of Health Sciences, ASST Santi Paolo e Carlo, Milan, Italy., Corbelli GM; Plus Onlus, Bologna, Italy., Santoro MM; Department of Experimental Medicine, University of Rome 'Tor Vergata,' Rome, Italy., Zazzi M; Department of Medical Biotechnology, University of Siena, Siena, Italy., Castagna A; Clinic of Infectious Diseases, IRCCS San Raffaele, Milan, Italy.; Clinic of Infectious Diseases, Vita-Salute San Raffaele University, Milan, Italy.
Jazyk: angličtina
Zdroj: Open forum infectious diseases [Open Forum Infect Dis] 2020 Sep 26; Vol. 7 (11), pp. ofaa456. Date of Electronic Publication: 2020 Sep 26 (Print Publication: 2020).
DOI: 10.1093/ofid/ofaa456
Abstrakt: Background: Currently, no data are available on the burden of morbidity and mortality in people with HIV-1 (PWH) harboring a 4-class drug-resistant (4DR) virus (nucleoside reverse transcriptase inhibitors, non-nucleoside reverse transcriptase inhibitors, protease inhibitors, integrase strand transfer inhibitors). The study aimed to assess the incidence of clinical events and death in this population.
Methods: This was a cohort study on PWH from the PRESTIGIO Registry with a documented 4DR virus. Burden of disease was defined as the occurrence of any new event including an AIDS-defining event (ADE) or non-AIDS-defining event (NADE) or death from any cause after 4DR evidence (baseline). Cox regression models evaluated factors associated with the risk of new clinical events/death.
Results: Among 148 PWH followed for a median (interquartile range) of 47 (32-84) months after 4DR evidence, 38 PWH had 62 new events or died from any cause (incidence rate, 9.12/100 person-years of follow-up; 95% CI = 6.85-11.39): 12 deaths (6 AIDS-related and 6 non-AIDS-related), 18 ADEs, 32 NADEs; 20 of the 38 NADEs (45%) of the incident clinical events were malignancies. The 4-year cumulative incidence of death was 6% (95% CI, 3%-13%), and that of ≥1 event or death was 22% (95% CI, 16%-31%). A higher risk of new clinical events/death was more likely in PWH with previous clinical events (adjusted hazard ratio [aHR], 2.67; 95% CI, 1.07-6.67) and marginally associated with lower baseline CD4+/CD8+ ratio (aHR, 0.82; 95% CI, 0.65-1.02).
Conclusions: PWH harboring 4DR have a high burden of disease with a worrying incidence of malignancies, strongly advising for close prevention and monitoring interventions as well as access to innovative therapeutic strategies, especially in people with a history of clinical events and low CD4+/CD8+ ratio.
(© The Author(s) 2020. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)
Databáze: MEDLINE
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