Clinical outcomes and risk factors for immune recovery and all-cause mortality in Latin Americans living with HIV with virological success: a retrospective cohort study.

Autor: Castillo-Rozas G; Laboratory of Molecular and Cellular Virology, Institute of Biomedical Sciences, Faculty of Medicine, University of Chile, Santiago, Chile.; HIV/AIDS Workgroup, Faculty of Medicine, University of Chile, Santiago, Chile., Tu S; Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA., Luz PM; Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil., Mejia F; Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Perú., Sierra-Madero J; Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México., Rouzier V; Groupe Haitien d'Etudes du Sarcome de Kaposi et des Infections Opportunistes, Port-au-Prince, Haiti., Shepherd BE; Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA., Cortes CP; HIV/AIDS Workgroup, Faculty of Medicine, University of Chile, Santiago, Chile.; Department of Internal Medicine, Faculty of Medicine, University of Chile, Santiago, Chile.; Hospital Clínico San Borja Arriarán & Fundación Arriarán, Santiago, Chile.; Millenium Institute on Immunology and Immunotherapy, Santiago, Chile.
Jazyk: angličtina
Zdroj: Journal of the International AIDS Society [J Int AIDS Soc] 2024 Mar; Vol. 27 (3), pp. e26214.
DOI: 10.1002/jia2.26214
Abstrakt: Introduction: Immune reconstitution following antiretroviral therapy (ART) initiation is crucial to prevent AIDS and non-AIDS-related comorbidities. Patients with suppressed viraemia who fail to restore cellular immunity are exposed to an increased risk of morbidity and mortality during long-term follow-up, although the underlying mechanisms remain poorly understood. We aim to describe clinical outcomes and factors associated with the worse immune recovery and all-cause mortality in people living with HIV (PLWH) from Latin America following ART initiation.
Methods: Retrospective cohort study using the CCASAnet database: PLWH ≥18 years of age at ART initiation using a three drug-based combination therapy and with medical follow-up for ≥24 months after ART initiation and undetectable viral load were included. Patients were divided into four immune recovery groups based on rounded quartiles of increase in CD4 T-cell count at 2 years of treatment (<150, [150, 250), [250, 350] and >350 cells/mm 3 ). Primary outcomes included all-cause mortality, AIDS-defining events and non-communicable diseases that occurred >2 years after ART initiation. Factors associated with an increase in CD4 T-cell count at 2 years of treatment were evaluated using a cumulative probability model with a logit link.
Results: In our cohort of 4496 Latin American PLWH, we found that patients with the lowest CD4 increase (<150) had the lowest survival probability at 10 years of follow-up. Lower increase in CD4 count following therapy initiation (and remarkably not a lower baseline CD4 T-cell count) and older age were risk factors for all-cause mortality. We also found that older age, male sex and higher baseline CD4 T-cell count were associated with lower CD4 count increase following therapy initiation.
Conclusions: Our study shows that PLWH with lower increases in CD4 count have lower survival probabilities. CD4 increase during follow-up might be a better predictor of mortality in undetectable PLWH than baseline CD4 count. Therefore, it should be included as a routine clinical variable to assess immune recovery and overall survival.
(© 2024 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of International AIDS Society.)
Databáze: MEDLINE
Externí odkaz:
Nepřihlášeným uživatelům se plný text nezobrazuje