Current and Past Immunodeficiency Are Associated With Higher Hospitalization Rates Among Persons on Virologically Suppressive Antiretroviral Therapy for up to 11 Years.

Autor:	Davy-Mendez T; Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.; School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA., Napravnik S; Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.; School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA., Eron JJ; Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.; School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA., Cole SR; Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA., van Duin D; School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA., Wohl DA; Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.; School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA., Hogan BC; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA., Althoff KN; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.; School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA., Gebo KA; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.; School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA., Moore RD; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.; School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA., Silverberg MJ; Kaiser Permanente Northern California, Oakland, California, USA., Horberg MA; Kaiser Permanente Mid-Atlantic Permanente Research Institute, Rockville, Maryland, USA., Gill MJ; Southern Alberta HIV Clinic, Calgary, Alberta, Canada., Mathews WC; School of Medicine, University of California, San Diego, San Diego, California, USA., Klein MB; Faculty of Medicine, McGill University, Montreal, Quebec, Canada., Colasanti JA; School of Medicine, Emory University, Atlanta, Georgia, USA., Sterling TR; School of Medicine, Vanderbilt University, Nashville, Tennessee, USA., Mayor AM; School of Medicine, Universidad Central del Caribe, Bayamon, Puerto Rico, USA., Rebeiro PF; School of Medicine, Vanderbilt University, Nashville, Tennessee, USA., Buchacz K; Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA., Li J; Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA., Nanditha NGA; Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada., Thorne JE; School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA., Nijhawan A; University of Texas Southwestern Medical Center, Dallas, Texas, USA., Berry SA; School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
Jazyk:	angličtina
Zdroj:	The Journal of infectious diseases [J Infect Dis] 2021 Aug 16; Vol. 224 (4), pp. 657-666. Date of Electronic Publication: 2020 Dec 26.
DOI:	10.1093/infdis/jiaa786
Abstrakt:	Background: Persons with human immunodeficiency virus (PWH) with persistently low CD4 counts despite efficacious antiretroviral therapy could have higher hospitalization risk. Methods: In 6 US and Canadian clinical cohorts, PWH with virologic suppression for ≥1 year in 2005-2015 were followed until virologic failure, loss to follow-up, death, or study end. Stratified by early (years 2-5) and long-term (years 6-11) suppression and lowest presuppression CD4 count <200 and ≥200 cells/µL, Poisson regression models estimated hospitalization incidence rate ratios (aIRRs) comparing patients by time-updated CD4 count category, adjusted for cohort, age, gender, calendar year, suppression duration, and lowest presuppression CD4 count. Results: The 6997 included patients (19 980 person-years) were 81% cisgender men and 40% white. Among patients with lowest presuppression CD4 count <200 cells/μL (44%), patients with current CD4 count 200-350 vs >500 cells/μL had aIRRs of 1.44 during early suppression (95% confidence interval [CI], 1.01-2.06), and 1.67 (95% CI, 1.03-2.72) during long-term suppression. Among patients with lowest presuppression CD4 count ≥200 (56%), patients with current CD4 351-500 vs >500 cells/μL had an aIRR of 1.22 (95% CI, .93-1.60) during early suppression and 2.09 (95% CI, 1.18-3.70) during long-term suppression. Conclusions: Virologically suppressed patients with lower CD4 counts experienced higher hospitalization rates and could potentially benefit from targeted clinical management strategies. (© The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu