The clinical benefits of antiretroviral therapy in severely immunocompromised HIV-1-infected patients with and without complete viral suppression

Amanda Mocroft; Wendy P Bannister; Ole Kirk; Justyna D Kowalska; Peter Reiss; Antonella D'Arminio-Monforte; Jose Gatell; Martin Fisher; Hanna Trocha; Aza Rakhmanova; Jens D Lundgren; EuroSIDA Study in EuroCOORD

doi:10.3851/imp2407

The clinical benefits of antiretroviral therapy in severely immunocompromised HIV-1-infected patients with and without complete viral suppression

Amanda Mocroft, Wendy P Bannister, Ole Kirk, Justyna D Kowalska, Peter Reiss, Antonella D'Arminio-Monforte, Jose Gatell, Martin Fisher, Hanna Trocha, Aza Rakhmanova, Jens D Lundgren, EuroSIDA Study in EuroCOORD

6 Citationer (Scopus)

Abstract

Background: The aim of this study was to determine whether there is a protective effect of combination antiretroviral therapy (cART) on the development of clinical events in patients with ongoing severe immunosuppression. Methods: A total of 3,780 patients from the EuroSIDA study under follow-up after 2001 with a current CD4⁺T-cell count ≤200 cells/mm³ were stratified into five groups: group 1, viral load (VL)<50 copies/ml on cART; group 2, VL 50-99,999 copies/ml on cART; group 3, VL 50-99,999 copies/ml off cART; group 4, VL≥100,000 copies/ml on cART; and group 5, VL≥100,000 copies/ml off cART. Poisson regression was used to identify the risk of (non-fatal or fatal) AIDS- and non-AIDS-related events considered together (AIDS/non-AIDS) or separately as AIDS or non-AIDS events within each group. Results: There were 428 AIDS/non-AIDS events during 3,780 person-years of follow-up. Compared with group 1, those in group 2 had a similar incidence of AIDS/non-AIDS events (incidence rate ratio [IRR] 1.04; 95% CI 0.79-1.36). Groups 3, 4 and 5 had significantly higher incidence rates of AIDS/non-AIDS events compared with group 1; incidence rates increased from group 3 (IRR 1.78; 95% CI 1.25-2.55) to group 5 (IRR 2.36; 95% CI 1.66-3.40), demonstrating the increased incidence of AIDS/non-AIDS events associated with increasing viraemia. After adjustment, the use of cART was associated with a 40% reduction in the incidence of AIDS/non-AIDS events in patients with VL 50-99,999 copies/ml (IRR 0.59; 95% CI 0.41-0.85) and in those with a VL>100,000 copies/ml (IRR 0.66; 95% CI 0.44-1.00). Similar relationships were seen for non-AIDS events and AIDS events when considered separately. Conclusions: In patients with ongoing severe immunosuppression, cART was associated with significant clinical benefits in patients with suboptimal virological control or virological failure.

Originalsprog	Engelsk
Tidsskrift	Antiviral Therapy
Vol/bind	17
Udgave nummer	7
Sider (fra-til)	1291-300
Antal sider	10
DOI	https://doi.org/10.3851/imp2407
Status	Udgivet - 2012

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10.3851/imp2407

https://journals.sagepub.com/doi/pdf/10.3851/IMP2407

Citationsformater

Mocroft, A., Bannister, W. P., Kirk, O., Kowalska, J. D., Reiss, P., D'Arminio-Monforte, A., Gatell, J., Fisher, M., Trocha, H., Rakhmanova, A., Lundgren, J. D., & EuroSIDA Study in EuroCOORD (2012). The clinical benefits of antiretroviral therapy in severely immunocompromised HIV-1-infected patients with and without complete viral suppression. Antiviral Therapy, 17(7), 1291-300. https://doi.org/10.3851/imp2407

Mocroft, A, Bannister, WP, Kirk, O, Kowalska, JD, Reiss, P, D'Arminio-Monforte, A, Gatell, J, Fisher, M, Trocha, H, Rakhmanova, A, Lundgren, JD & EuroSIDA Study in EuroCOORD 2012, 'The clinical benefits of antiretroviral therapy in severely immunocompromised HIV-1-infected patients with and without complete viral suppression', Antiviral Therapy, bind 17, nr. 7, s. 1291-300. https://doi.org/10.3851/imp2407

@article{35a854d6cc344508a5ff463d0ce5572d,

title = "The clinical benefits of antiretroviral therapy in severely immunocompromised HIV-1-infected patients with and without complete viral suppression",

abstract = "Background: The aim of this study was to determine whether there is a protective effect of combination antiretroviral therapy (cART) on the development of clinical events in patients with ongoing severe immunosuppression. Methods: A total of 3,780 patients from the EuroSIDA study under follow-up after 2001 with a current CD4+T-cell count ≤200 cells/mm3 were stratified into five groups: group 1, viral load (VL)<50 copies/ml on cART; group 2, VL 50-99,999 copies/ml on cART; group 3, VL 50-99,999 copies/ml off cART; group 4, VL≥100,000 copies/ml on cART; and group 5, VL≥100,000 copies/ml off cART. Poisson regression was used to identify the risk of (non-fatal or fatal) AIDS- and non-AIDS-related events considered together (AIDS/non-AIDS) or separately as AIDS or non-AIDS events within each group. Results: There were 428 AIDS/non-AIDS events during 3,780 person-years of follow-up. Compared with group 1, those in group 2 had a similar incidence of AIDS/non-AIDS events (incidence rate ratio [IRR] 1.04; 95% CI 0.79-1.36). Groups 3, 4 and 5 had significantly higher incidence rates of AIDS/non-AIDS events compared with group 1; incidence rates increased from group 3 (IRR 1.78; 95% CI 1.25-2.55) to group 5 (IRR 2.36; 95% CI 1.66-3.40), demonstrating the increased incidence of AIDS/non-AIDS events associated with increasing viraemia. After adjustment, the use of cART was associated with a 40% reduction in the incidence of AIDS/non-AIDS events in patients with VL 50-99,999 copies/ml (IRR 0.59; 95% CI 0.41-0.85) and in those with a VL>100,000 copies/ml (IRR 0.66; 95% CI 0.44-1.00). Similar relationships were seen for non-AIDS events and AIDS events when considered separately. Conclusions: In patients with ongoing severe immunosuppression, cART was associated with significant clinical benefits in patients with suboptimal virological control or virological failure.",

keywords = "Acquired Immunodeficiency Syndrome, Adult, CD4 Lymphocyte Count, Drug Evaluation, Drug Therapy, Combination, Female, Follow-Up Studies, HIV Protease Inhibitors, HIV-1, Humans, Immunocompromised Host, Incidence, Male, Middle Aged, Poisson Distribution, Prospective Studies, Reverse Transcriptase Inhibitors, Risk Factors, Viral Load, Viremia",

author = "Amanda Mocroft and Bannister, {Wendy P} and Ole Kirk and Kowalska, {Justyna D} and Peter Reiss and Antonella D'Arminio-Monforte and Jose Gatell and Martin Fisher and Hanna Trocha and Aza Rakhmanova and Lundgren, {Jens D} and {EuroSIDA Study in EuroCOORD}",

year = "2012",

doi = "10.3851/imp2407",

language = "English",

volume = "17",

pages = "1291--300",

journal = "Antiviral Therapy",

issn = "1359-6535",

publisher = "International Medical Press",

number = "7",

}

TY - JOUR

T1 - The clinical benefits of antiretroviral therapy in severely immunocompromised HIV-1-infected patients with and without complete viral suppression

AU - Mocroft, Amanda

AU - Bannister, Wendy P

AU - Kirk, Ole

AU - Kowalska, Justyna D

AU - Reiss, Peter

AU - D'Arminio-Monforte, Antonella

AU - Gatell, Jose

AU - Fisher, Martin

AU - Trocha, Hanna

AU - Rakhmanova, Aza

AU - Lundgren, Jens D

AU - EuroSIDA Study in EuroCOORD

PY - 2012

Y1 - 2012

N2 - Background: The aim of this study was to determine whether there is a protective effect of combination antiretroviral therapy (cART) on the development of clinical events in patients with ongoing severe immunosuppression. Methods: A total of 3,780 patients from the EuroSIDA study under follow-up after 2001 with a current CD4+T-cell count ≤200 cells/mm3 were stratified into five groups: group 1, viral load (VL)<50 copies/ml on cART; group 2, VL 50-99,999 copies/ml on cART; group 3, VL 50-99,999 copies/ml off cART; group 4, VL≥100,000 copies/ml on cART; and group 5, VL≥100,000 copies/ml off cART. Poisson regression was used to identify the risk of (non-fatal or fatal) AIDS- and non-AIDS-related events considered together (AIDS/non-AIDS) or separately as AIDS or non-AIDS events within each group. Results: There were 428 AIDS/non-AIDS events during 3,780 person-years of follow-up. Compared with group 1, those in group 2 had a similar incidence of AIDS/non-AIDS events (incidence rate ratio [IRR] 1.04; 95% CI 0.79-1.36). Groups 3, 4 and 5 had significantly higher incidence rates of AIDS/non-AIDS events compared with group 1; incidence rates increased from group 3 (IRR 1.78; 95% CI 1.25-2.55) to group 5 (IRR 2.36; 95% CI 1.66-3.40), demonstrating the increased incidence of AIDS/non-AIDS events associated with increasing viraemia. After adjustment, the use of cART was associated with a 40% reduction in the incidence of AIDS/non-AIDS events in patients with VL 50-99,999 copies/ml (IRR 0.59; 95% CI 0.41-0.85) and in those with a VL>100,000 copies/ml (IRR 0.66; 95% CI 0.44-1.00). Similar relationships were seen for non-AIDS events and AIDS events when considered separately. Conclusions: In patients with ongoing severe immunosuppression, cART was associated with significant clinical benefits in patients with suboptimal virological control or virological failure.

AB - Background: The aim of this study was to determine whether there is a protective effect of combination antiretroviral therapy (cART) on the development of clinical events in patients with ongoing severe immunosuppression. Methods: A total of 3,780 patients from the EuroSIDA study under follow-up after 2001 with a current CD4+T-cell count ≤200 cells/mm3 were stratified into five groups: group 1, viral load (VL)<50 copies/ml on cART; group 2, VL 50-99,999 copies/ml on cART; group 3, VL 50-99,999 copies/ml off cART; group 4, VL≥100,000 copies/ml on cART; and group 5, VL≥100,000 copies/ml off cART. Poisson regression was used to identify the risk of (non-fatal or fatal) AIDS- and non-AIDS-related events considered together (AIDS/non-AIDS) or separately as AIDS or non-AIDS events within each group. Results: There were 428 AIDS/non-AIDS events during 3,780 person-years of follow-up. Compared with group 1, those in group 2 had a similar incidence of AIDS/non-AIDS events (incidence rate ratio [IRR] 1.04; 95% CI 0.79-1.36). Groups 3, 4 and 5 had significantly higher incidence rates of AIDS/non-AIDS events compared with group 1; incidence rates increased from group 3 (IRR 1.78; 95% CI 1.25-2.55) to group 5 (IRR 2.36; 95% CI 1.66-3.40), demonstrating the increased incidence of AIDS/non-AIDS events associated with increasing viraemia. After adjustment, the use of cART was associated with a 40% reduction in the incidence of AIDS/non-AIDS events in patients with VL 50-99,999 copies/ml (IRR 0.59; 95% CI 0.41-0.85) and in those with a VL>100,000 copies/ml (IRR 0.66; 95% CI 0.44-1.00). Similar relationships were seen for non-AIDS events and AIDS events when considered separately. Conclusions: In patients with ongoing severe immunosuppression, cART was associated with significant clinical benefits in patients with suboptimal virological control or virological failure.

KW - Acquired Immunodeficiency Syndrome

KW - Adult

KW - CD4 Lymphocyte Count

KW - Drug Evaluation

KW - Drug Therapy, Combination

KW - Female

KW - Follow-Up Studies

KW - HIV Protease Inhibitors

KW - HIV-1

KW - Humans

KW - Immunocompromised Host

KW - Incidence

KW - Male

KW - Middle Aged

KW - Poisson Distribution

KW - Prospective Studies

KW - Reverse Transcriptase Inhibitors

KW - Risk Factors

KW - Viral Load

KW - Viremia

U2 - 10.3851/imp2407

DO - 10.3851/imp2407

M3 - Journal article

C2 - 23013779

SN - 1359-6535

VL - 17

SP - 1291

EP - 1300

JO - Antiviral Therapy

JF - Antiviral Therapy

IS - 7

ER -

The clinical benefits of antiretroviral therapy in severely immunocompromised HIV-1-infected patients with and without complete viral suppression

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