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2022-08-03

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cc-by-nc-nd (c) Martin-Iguacel, Raquel et al., 2022
Si us plau utilitzeu sempre aquest identificador per citar o enllaçar aquest document: https://hdl.handle.net/2445/194337

Determinants of long-term survival in late HIV presenters: the prospective PISCIS cohort study

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https://doi.org/10.1016/j.eclinm.2022.101600

Resum

Background: Late HIV diagnosis (i.e CD4≤350 cells/µL) is associated with poorer outcomes. However, determinants of long-term mortality and factors influencing immune recovery within the first years after antiretroviral treatment (ART) initiation are poorly defined. Methods: From PISCIS cohort, we included all HIV-positive adults, two-year survivors after initiating ART between 2005-2019. The primary outcome was all-cause mortality according to the two-year CD4 count. We used Poisson regression. The secondary outcome was incomplete immune recovery (i.e., two-year CD4<500 cells/µL). We used logistic regression and propensity score matching. Findings: We included 2,719 participants (16593·1 person-years): 1441 (53%) late presenters (LP) and 1278 non-LP (1145 non-LP with two-year CD4 count >500 cells/µL, reference population). Overall, 113 patients (4·2%) died. Mortality was higher among LP with two-year CD4 count 200-500 cells/µL (aMRR 1·95[95%CI:1·06-3·61]) or <200 cells/µL (aMRR 4·59[2·25-9·37]).Conversely, no differences were observed in participants with two-year CD4 counts >500 cells/µL, regardless of being initially LP or non-LP (aMRR 1·05[0·50-2·21]). Mortality rates within each two-year CD4 strata were not affected by the initial CD4 count at ART initiation (test-interaction, p = 0·48). The stronger factor influencing immune recovery was the CD4 count at ART initiation. First-line integrase-inhibitor-(INSTI)-based regimens were associated with reduced mortality compared to other regimens (aMRR 0·54[0·31-0·93]) and reduced risk of incomplete immune recovery in LP (aOR 0·70[0·52-0·95]). Interpretation: Two-year immune recovery is a good early predictor of long-term mortality in LP after surviving the first high-risk 2 years. Nearly half experienced a favorable immune recovery with a life expectancy similar to non-LP. INSTI-based regimens were associated with higher rates of successful immune recovery and better survival compared to non-INSTI regimens.

Matèries

VIH (Virus), Antiretrovirals, Mortalitat, Resposta immunitària

Matèries (anglès)

HIV (Viruses), Antiretroviral agents, Mortality, Immune response

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Articles publicats en revistes (Medicina)
Articles publicats en revistes (IDIBAPS: Institut d'investigacions Biomèdiques August Pi i Sunyer)
Articles publicats en revistes (Institut d'lnvestigació Biomèdica de Bellvitge (IDIBELL))

Citació

MARTIN-IGUACEL, Raquel, REYES-URUEÑA, Juliana maria, BRUGUERA, Andreu, ACEITON, Jordi, DÍAZ, Yesika, MORENO-FORNÉS, Sergio, DOMINGO, Pere (domingo pedrol), BURGOS-CIBRIAN, Joaquín, TIRABOSCHI, Juan manuel, JOHANSEN, Isik somuncu, ÁLVAREZ, Hortensia, MIRÓ MEDA, José m. (josé maría), CASABONA, Jordi, LLIBRE, Josep m., PISCIS study group. Determinants of long-term survival in late HIV presenters: the prospective PISCIS cohort study. _Eclinicalmedicine_. 2022. Vol. 52, núm. 101600. [consulta: 7 de febrer de 2026]. ISSN: 2589-5370. [Disponible a: https://hdl.handle.net/2445/194337]

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