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 Citations (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.

Original language	English
Journal	Antiviral Therapy
Volume	17
Issue number	7
Pages (from-to)	1291-300
Number of pages	10
DOIs	https://doi.org/10.3851/imp2407
Publication status	Published - 2012

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

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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

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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, vol. 17, no. 7, pp. 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

Abstract

Keywords

UN SDGs

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