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Trickey A, McGinnis K, Gill MJ, Abgrall S, Berenguer J, Wyen C, Hessamfar M, Reiss P, Kusejko K, Silverberg MJ, Imaz A, Teira R, d'Arminio Monforte A, Zangerle R, Guest JL, Papastamopoulos V, Crane H, Sterling TR, Grabar S, Ingle SM, Sterne JAC. Longitudinal trends in causes of death among adults with HIV on antiretroviral therapy in Europe and North America from 1996 to 2020: a collaboration of cohort studies. Lancet HIV 2024; 11:e176-e185. [PMID: 38280393 DOI: 10.1016/s2352-3018(23)00272-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 10/13/2023] [Accepted: 10/17/2023] [Indexed: 01/29/2024]
Abstract
BACKGROUND Mortality rates among people with HIV have fallen since 1996 following the widespread availability of effective antiretroviral therapy (ART). Patterns of cause-specific mortality are evolving as the population with HIV ages. We aimed to investigate longitudinal trends in cause-specific mortality among people with HIV starting ART in Europe and North America. METHODS In this collaborative observational cohort study, we used data from 17 European and North American HIV cohorts contributing data to the Antiretroviral Therapy Cohort Collaboration. We included data for people with HIV who started ART between 1996 and 2020 at the age of 16 years or older. Causes of death were classified into a single cause by both a clinician and an algorithm if International Classification of Diseases, Ninth Revision or Tenth Revision data were available, or independently by two clinicians. Disagreements were resolved through panel discussion. We used Poisson models to compare cause-specific mortality rates during the calendar periods 1996-99, 2000-03, 2004-07, 2008-11, 2012-15, and 2016-20, adjusted for time-updated age, CD4 count, and whether the individual was ART-naive at the start of each period. FINDINGS Among 189 301 people with HIV included in this study, 16 832 (8·9%) deaths were recorded during 1 519 200 person-years of follow-up. 13 180 (78·3%) deaths were classified by cause: the most common causes were AIDS (4203 deaths; 25·0%), non-AIDS non-hepatitis malignancy (2311; 13·7%), and cardiovascular or heart-related (1403; 8·3%) mortality. The proportion of deaths due to AIDS declined from 49% during 1996-99 to 16% during 2016-20. Rates of all-cause mortality per 1000 person-years decreased from 16·8 deaths (95% CI 15·4-18·4) during 1996-99 to 7·9 deaths (7·6-8·2) during 2016-20. Rates of all-cause mortality declined with time: the average adjusted mortality rate ratio per calendar period was 0·85 (95% CI 0·84-0·86). Rates of cause-specific mortality also declined: the most pronounced reduction was for AIDS-related mortality (0·81; 0·79-0·83). There were also reductions in rates of cardiovascular-related (0·83, 0·79-0·87), liver-related (0·88, 0·84-0·93), non-AIDS infection-related (0·91, 0·86-0·96), non-AIDS-non-hepatocellular carcinoma malignancy-related (0·94, 0·90-0·97), and suicide or accident-related mortality (0·89, 0·82-0·95). Mortality rates among people who acquired HIV through injecting drug use increased in women (1·07, 1·00-1·14) and decreased slightly in men (0·96, 0·93-0·99). INTERPRETATION Reductions of most major causes of death, particularly AIDS-related deaths among people with HIV on ART, were not seen for all subgroups. Interventions targeted at high-risk groups, substance use, and comorbidities might further increase life expectancy in people with HIV towards that in the general population. FUNDING US National Institute on Alcohol Abuse and Alcoholism.
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Affiliation(s)
- Adam Trickey
- Population Health Sciences, University of Bristol, Bristol, UK.
| | | | - M John Gill
- Department of Medicine, University of Calgary, South Alberta HIV Clinic, Calgary, AB, Canada
| | - Sophie Abgrall
- Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Béclère, Service de Médecine Interne, Clamart, France; APHP, Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP INSERM U1018, Le Kremlin-Bicêtre, France
| | - Juan Berenguer
- Hospital General Universitario Gregorio Marañón, IiSGM, CIBERINFEC, Madrid, Spain
| | - Christoph Wyen
- Department I for Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Mojgan Hessamfar
- University of Bordeaux, ISPED, INSERM U1219, Bordeaux, France; Centre Hospitalier Universitaire (CHU) de Bordeaux, Bordeaux, France
| | - Peter Reiss
- Stichting HIV Monitoring, Amsterdam, Netherlands; Amsterdam UMC, University of Amsterdam, Global Health, Amsterdam, Netherlands; Amsterdam Institute for Global Health and Development, Amsterdam, Netherlands
| | - Katharina Kusejko
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland; Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | | | - Arkaitz Imaz
- Department of Infectious Diseases, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L'Hospitalet de Llobregat, Spain
| | - Ramon Teira
- Servicio de Medicina Interna, Hospital Universitario de Sierrallana, Torrelavega, Spain
| | | | - Robert Zangerle
- Department of Dermatology, Venereology and Allergy, Medical University Innsbruck, Innsbruck, Austria
| | - Jodie L Guest
- Atlanta VA Medical Center, Decatur, GA, USA; Rollins School of Public Health at Emory University, Atlanta, GA, USA
| | - Vasileios Papastamopoulos
- 5th Department of Internal Medicine & Infectious Diseases Unit, Evangelismos General Hospital, Athens, Greece
| | - Heidi Crane
- Division of Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Timothy R Sterling
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Sophie Grabar
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), Paris, France; Department of Public Health, AP-HP, St Antoine hospital, Paris, France
| | - Suzanne M Ingle
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Jonathan A C Sterne
- Population Health Sciences, University of Bristol, Bristol, UK; NIHR Bristol Biomedical Research Centre, Bristol, UK; Health Data Research UK South-West, Bristol, UK
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2
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Silverberg MJ, Levine TM, Lea AN, Williams AE, Alexeeff SE, Bryant K, Cavassini M, Flamm JA, Hare CB, Ingle SM, Justice AC, Lam JO, Sterling SA, Horberg MA, Satre DD. Cardiovascular Disease Risk Factor Control in People With and Without Human Immunodeficiency Virus. Clin Infect Dis 2024:ciad728. [PMID: 38227614 DOI: 10.1093/cid/ciad728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Management of hypertension, dyslipidemia, diabetes and other modifiable factors may mitigate the cardiovascular disease (CVD) risk in people with human immunodeficiency virus (HIV, PWH) compared with people without HIV (PWoH). METHODS This was a retrospective cohort study of 8285 PWH and 170 517 PWoH from an integrated health system. Risk factor control was measured using a novel disease management index (DMI) accounting for amount/duration above treatment goals (0% to 100% [perfect control]), including 2 DMIs for hypertension (diastolic and systolic blood pressure), 3 for dyslipidemia (low-density lipoprotein, total cholesterol, triglycerides), and 1 for diabetes (HbA1c). CVD risk by HIV status was evaluated overall and in subgroups defined by DMIs, smoking, alcohol use, and overweight/obesity in adjusted Cox proportional hazards models. RESULTS PWH and PWoH had similar DMIs (80%-100%) except for triglycerides (worse for PWH) and HbA1c (better for PWH). In adjusted models, PWH had an elevated risk of CVD compared with PWoH (hazard ratio [HR], 1.18; 95% confidence interval [CI], 1.07-1.31). This association was attenuated in subgroups with controlled dyslipidemia and diabetes but remained elevated for PWH with controlled hypertension or higher total cholesterol. The strongest HIV status association with CVD was seen in the subgroup with frequent unhealthy alcohol use (HR, 2.13; 95% CI, 1.04-4.34). CONCLUSIONS Control of dyslipidemia and diabetes, but not hypertension, attenuated the HIV status association with CVD. The strong association of HIV and CVD with frequent unhealthy alcohol use suggests enhanced screening and treatment of alcohol problems in PWH is warranted.
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Affiliation(s)
- Michael J Silverberg
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Tory M Levine
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Alexandra N Lea
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Andrew E Williams
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts, USA
| | - Stacey E Alexeeff
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Kendall Bryant
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland, USA
| | - Matthias Cavassini
- Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Jason A Flamm
- Kaiser Permanente Sacramento Medical Center, Sacramento, California, USA
| | - C Bradley Hare
- Kaiser Permanente SanFrancisco Medical Center, San Francisco, California, USA
| | - Suzanne M Ingle
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Amy C Justice
- VA Connecticut Healthcare System, Yale University Schools of Medicine and Public Health, New Haven, Connecticut, USA
| | - Jennifer O Lam
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Stacy A Sterling
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Michael A Horberg
- Kaiser Permanente Mid-Atlantic Permanente Research Institute, Rockville, Maryland, USA
| | - Derek D Satre
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, SanFrancisco, California, USA
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3
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Trickey A, Glaubius R, Pantazis N, Zangerle R, Wittkop L, Vehreschild J, Grabar S, Cavassini M, Teira R, d’Arminio Monforte A, Casabona J, van Sighem A, Jarrin I, Ingle SM, Sterne JAC, Imai-Eaton JW, Johnson LF. Estimation of Improvements in Mortality in Spectrum Among Adults With HIV Receiving Antiretroviral Therapy in High-Income Countries. J Acquir Immune Defic Syndr 2024; 95:e89-e96. [PMID: 38180742 PMCID: PMC10769170 DOI: 10.1097/qai.0000000000003326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
INTRODUCTION Mortality rates for people living with HIV (PLHIV) on antiretroviral therapy (ART) in high-income countries continue to decline. We compared mortality rates among PLHIV on ART in Europe for 2016-2020 with Spectrum's estimates. METHODS The AIDS Impact Module in Spectrum is a compartmental HIV epidemic model coupled with a demographic population projection model. We used national Spectrum projections developed for the 2022 HIV estimates round to calculate mortality rates among PLHIV on ART, adjusting to the age/country distribution of PLHIV starting ART from 1996 to 2020 in the Antiretroviral Therapy Cohort Collaboration (ART-CC)'s European cohorts. RESULTS In the ART-CC, 11,504 of 162,835 PLHIV died. Between 1996-1999 and 2016-2020, AIDS-related mortality in the ART-CC decreased from 8.8 (95% CI: 7.6 to 10.1) to 1.0 (0.9-1.2) and from 5.9 (4.4-8.1) to 1.1 (0.9-1.4) deaths per 1000 person-years among men and women, respectively. Non-AIDS-related mortality decreased from 9.1 (7.9-10.5) to 6.1 (5.8-6.5) and from 7.0 (5.2-9.3) to 4.8 (4.3-5.2) deaths per 1000 person-years among men and women, respectively. Adjusted all-cause mortality rates in Spectrum among men were near ART-CC estimates for 2016-2020 (Spectrum: 7.02-7.47 deaths per 1000 person-years) but approximately 20% lower in women (Spectrum: 4.66-4.70). Adjusted excess mortality rates in Spectrum were 2.5-fold higher in women and 3.1-3.4-fold higher in men in comparison to the ART-CC's AIDS-specific mortality rates. DISCUSSION Spectrum's all-cause mortality estimates among PLHIV are consistent with age/country-controlled mortality observed in ART-CC, with some underestimation of mortality among women. Comparing results suggest that 60%-70% of excess deaths among PLHIV on ART in Spectrum are from non-AIDS causes.
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Affiliation(s)
- Adam Trickey
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Robert Glaubius
- Center for Modeling, Planning and Policy Analysis, Avenir Health, Glastonbury, CT
| | - Nikos Pantazis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Robert Zangerle
- Department of Dermatology, Venereology and Allergy, Medical University Innsbruck, Innsbruck, Austria
| | - Linda Wittkop
- Univ. Bordeaux, INSERM, Institut Bergonié, BPH, U1219, CIC-EC 1401, Bordeaux, France
- INRIA SISTM Team, Talence, France
- CHU de Bordeaux, Service d'information médicale, INSERM, Institut Bergonié, CIC-EC 1401, Bordeaux, France
| | - Janne Vehreschild
- Department I for Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Sophie Grabar
- Sorbonne Université, INSERM, Institut Pierre Louis d’Épidémiologie et de Santé Publique (IPLESP), Paris, France
- Department of Public Health, AP-HP, St Antoine Hospital, Paris, France
| | - Matthias Cavassini
- Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Ramon Teira
- Servicio de Medicina Interna, Hospital Universitario de Sierrallana, Torrelavega, Cantabria, Spain
| | | | - Jordi Casabona
- Centre d'Estudis Epidemiològics sobre la SIDA i les ITS de Catalunya (CEEISCAT), Institut de Recerca en Ciències de la Salut Germans Trias i Pujol (IGTP), Campus de Can Ruti, Badalona, Catalonia, Spain
| | | | - Inma Jarrin
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain
- CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
| | - Suzanne M. Ingle
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Jonathan A. C. Sterne
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
- National Institute for Health and Care Research Bristol Biomedical Research Centre, Bristol, United Kingdom
- Health Data Research UK South-West, Bristol, United Kingdom
| | - Jeffrey W. Imai-Eaton
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA; and
| | - Leigh F. Johnson
- Centre for Infectious Disease Epidemiology and Research, School of Public Health, University of Cape Town, Cape Town, South Africa
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4
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Loosli T, Hossmann S, Ingle SM, Okhai H, Kusejko K, Mouton J, Bellecave P, van Sighem A, Stecher M, d'Arminio Monforte A, Gill MJ, Sabin CA, Maartens G, Günthard HF, Sterne JAC, Lessells R, Egger M, Kouyos RD. HIV-1 drug resistance in people on dolutegravir-based antiretroviral therapy: a collaborative cohort analysis. Lancet HIV 2023; 10:e733-e741. [PMID: 37832567 PMCID: PMC10913014 DOI: 10.1016/s2352-3018(23)00228-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 08/08/2023] [Accepted: 08/25/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND The widespread use of the integrase strand transfer inhibitor (INSTI) dolutegravir in first-line and second-line antiretroviral therapy (ART) might facilitate emerging resistance. The DTG RESIST study combined data from HIV cohorts to examine patterns of drug resistance mutations (DRMs) and identify risk factors for dolutegravir resistance. METHODS We included cohorts with INSTI resistance data from two collaborations (ART Cohort Collaboration, International epidemiology Databases to Evaluate AIDS in Southern Africa), and the UK Collaborative HIV Cohort. Eight cohorts from Canada, France, Germany, Italy, the Netherlands, Switzerland, South Africa, and the UK contributed data on individuals who were viraemic on dolutegravir-based ART and underwent genotypic resistance testing. Individuals with unknown dolutegravir initiation date were excluded. Resistance levels were categorised using the Stanford algorithm. We identified risk factors for resistance using mixed-effects ordinal logistic regression models. FINDINGS We included 599 people with genotypic resistance testing on dolutegravir-based ART between May 22, 2013, and Dec 20, 2021. Most had HIV-1 subtype B (n=351, 59%), a third had been exposed to first-generation INSTIs (n=193, 32%), 70 (12%) were on dolutegravir dual therapy, and 18 (3%) were on dolutegravir monotherapy. INSTI DRMs were detected in 86 (14%) individuals; 20 (3%) had more than one mutation. Most (n=563, 94%) were susceptible to dolutegravir, seven (1%) had potential low, six (1%) low, 17 (3%) intermediate, and six (1%) high-level dolutegravir resistance. The risk of dolutegravir resistance was higher on dolutegravir monotherapy (adjusted odds ratio [aOR] 34·1, 95% CI 9·93-117) and dolutegravir plus lamivudine dual therapy (aOR 9·21, 2·20-38·6) compared with combination ART, and in the presence of potential low or low (aOR 5·23, 1·32-20·7) or intermediate or high-level (aOR 13·4, 4·55-39·7) nucleoside reverse transcriptase inhibitor (NRTI) resistance. INTERPRETATION Among people with viraemia on dolutegravir-based ART, INSTI DRMs and dolutegravir resistance were rare. NRTI resistance substantially increased the risk of dolutegravir resistance, which is of concern, notably in resource-limited settings. Monitoring is important to prevent resistance at the individual and population level and ensure the long-term sustainability of ART. FUNDING US National Institutes of Health, Swiss National Science Foundation.
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Affiliation(s)
- Tom Loosli
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland; Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Stefanie Hossmann
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Suzanne M Ingle
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Hajra Okhai
- Institute for Global Health, University College London, London, UK
| | - Katharina Kusejko
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland; Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Johannes Mouton
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | | | | | - Melanie Stecher
- German Center for Infection Research (DZIF), Partner-Site Cologne-Bonn, Cologne, Germany; Department I of Internal Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | | | - M John Gill
- Southern Alberta Clinic, Calgary, AB, Canada; Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Caroline A Sabin
- Institute for Global Health, University College London, London, UK
| | - Gary Maartens
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Huldrych F Günthard
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland; Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Jonathan A C Sterne
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Richard Lessells
- KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), University of KwaZulu-Natal, Durban, South Africa; Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
| | - Matthias Egger
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; Centre for Infectious Disease Epidemiology and Research, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
| | - Roger D Kouyos
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland; Institute of Medical Virology, University of Zurich, Zurich, Switzerland
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5
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Rein SM, Lodi S, Logan RW, Touloumi G, Antoniadou A, Wittkop L, Bonnet F, van Sighem A, van der Valk M, Reiss P, Klein MB, Young J, Jarrin I, d'Arminio Monforte A, Tavelli A, Meyer L, Tran L, Gill MJ, Lang R, Surial B, Haas AD, Justice AC, Rentsch CT, Phillips A, Sabin CA, Miro JM, Trickey A, Ingle SM, Sterne JAC, Hernán MA. Integrase strand-transfer inhibitor use and cardiovascular events in adults with HIV: an emulation of target trials in the HIV-CAUSAL Collaboration and the Antiretroviral Therapy Cohort Collaboration. Lancet HIV 2023; 10:e723-e732. [PMID: 37923486 PMCID: PMC10695103 DOI: 10.1016/s2352-3018(23)00233-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 08/21/2023] [Accepted: 09/01/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND A recent observational study suggested that the risk of cardiovascular events could be higher among antiretroviral therapy (ART)-naive individuals with HIV who receive integrase strand-transfer inhibitor (INSTI)-based ART than among those who receive other ART regimens. We aimed to emulate target trials separately in ART-naive and ART-experienced individuals with HIV to examine the effect of using INSTI-based regimens versus other ART regimens on the 4-year risk of cardiovascular events. METHODS We used routinely recorded clinical data from 12 cohorts that collected information on cardiovascular events, BMI, and blood pressure from two international consortia of cohorts of people with HIV from Europe and North America. For the target trial in individuals who had previously never used ART (ie, ART-naive), eligibility criteria were aged 18 years or older, a detectable HIV-RNA measurement while ART-naive (>50 copies per mL), and no history of a cardiovascular event or cancer. Eligibility criteria for the target trial in those with previous use of non-INSTI-based ART (ie, ART-experienced) were the same except that individuals had to have been on at least one non-INSTI-based ART regimen and be virally suppressed (≤50 copies per mL). We assessed eligibility for both trials for each person-month between January, 2013, and January, 2023, and assigned individuals to the treatment strategy that was compatible with their data. We estimated the standardised 4-year risks of cardiovascular events (myocardial infarction, stroke, or invasive cardiovascular procedure) via pooled logistic regression models adjusting for time and baseline covariates. In per-protocol analyses, we censored individuals if they deviated from their assigned treatment strategy for more than 2 months and weighted uncensored individuals by the inverse of their time-varying probability of remaining uncensored. The denominator of the weight was estimated via a pooled logistic model that included baseline and time-varying covariates. FINDINGS The analysis in ART-naive individuals included 10 767 INSTI initiators and 8292 non-initiators of INSTI. There were 43 cardiovascular events in INSTI initiators (median follow-up of 29 months; IQR 15-45) and 52 in non-initiators (39 months; 18-47): standardised 4-year risks were 0·76% (95% CI 0·51 to 1·04) in INSTI initiators and 0·75% (0·54 to 0·98) in non-INSTI initiators; risk ratio 1·01 (0·57 to 1·57); risk difference 0·0089% (-0·43 to 0·36). The analysis in ART-experienced individuals included 7875 INSTI initiators and 373 965 non-initiators. There were 56 events in INSTI initiators (median follow-up 18 months; IQR 9-29) and 3103 events (808 unique) in non-INSTI initiators (26 months; 15-37) in non-initiators: standardised 4-year risks 1·41% (95% CI 0·88 to 2·03) in INSTI initiators and 1·48% (1·28 to 1·71) in non-initiators; risk ratio 0·95 (0·60 to 1·36); risk difference -0·068% (-0·60 to 0·52). INTERPRETATION We estimated that INSTI use did not result in a clinically meaningful increase of cardiovascular events in ART-naive and ART-experienced individuals with HIV. FUNDING National Institute of Allergy and Infectious Diseases and National Institute on Alcohol Abuse and Alcoholism.
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Affiliation(s)
- Sophia M Rein
- CAUSALab and Department of Epidemiology, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA.
| | - Sara Lodi
- CAUSALab and Department of Epidemiology, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA; Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Roger W Logan
- CAUSALab and Department of Epidemiology, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Giota Touloumi
- Department of Hygiene, Epidemiology, & Medical Statistics, Medical School, National & Kapodistrian University of Athens, Athens, Greece
| | - Anastasia Antoniadou
- 4th Department of Internal Medicine, Attikon University General Hospital, Medical School, National & Kapodistrian University of Athens, Athens, Greece
| | - Linda Wittkop
- University of Bordeaux, INSERM, Bordeaux Population Health-U1219, CIC1401-EC, Bordeaux, France; SISTM, INRIA, Talence, France; CHU de Bordeaux, Bordeaux University Hospital, Service d'information médicale, INSERM, CIC-EC 1401, Bordeaux, France
| | - Fabrice Bonnet
- University of Bordeaux, INSERM, Bordeaux Population Health-U1219, CIC1401-EC, Bordeaux, France; CHU de Bordeaux, Bordeaux University Hospital, Service d'information médicale, INSERM, CIC-EC 1401, Bordeaux, France
| | | | - Marc van der Valk
- Stichting HIV Monitoring, Amsterdam, Netherlands; Amsterdam UMC, Department of Infectious Diseases, University of Amsterdam, Amsterdam, Netherlands; Amsterdam Institute for Infection and Immunity, Amsterdam, Netherlands
| | - Peter Reiss
- Department of Global Health, University of Amsterdam, Amsterdam, Netherlands; Amsterdam Institute for Infection and Immunity, Amsterdam, Netherlands; Amsterdam Institute for Global Health and Development, Amsterdam, Netherlands
| | - Marina B Klein
- Division of Infectious Diseases and Chronic Viral Illness Service, Department of Medicine, McGill University Health Centre and Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - James Young
- Division of Infectious Diseases and Chronic Viral Illness Service, Department of Medicine, McGill University Health Centre and Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Inmaculada Jarrin
- Centro Nacional de Epidemiologia, Institute of Health Carlos III, Madrid, Spain; CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | | | | | - Laurence Meyer
- INSERM U1018, Université Paris Saclay, Centre de recherche en Epidémiologie et Santé des Populations (CESP), Le Kremlin-Bicêtre, France; Assistance Publique-Hôpitaux de Paris, Université Paris-Saclay, Service de Santé Publique, Hôpital Bicêtr, Le Kremlin-Bicêtre, France
| | - Laurent Tran
- INSERM U1018, Université Paris Saclay, Centre de recherche en Epidémiologie et Santé des Populations (CESP), Le Kremlin-Bicêtre, France
| | - Michael J Gill
- Southern Alberta Clinic and Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Raynell Lang
- Southern Alberta Clinic and Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Bernard Surial
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andreas D Haas
- Institute of Social & Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Amy C Justice
- Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, CT, USA; Department of Health Policy, Yale School of Public Health, Yale University, New Haven, CT, USA; VA Connecticut Healthcare System, US Department of Veterans Affairs, New Haven, Connecticut, USA
| | - Christopher T Rentsch
- Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, CT, USA; VA Connecticut Healthcare System, US Department of Veterans Affairs, New Haven, Connecticut, USA; Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Andrew Phillips
- Institute for Global Health, University College London, London, UK
| | - Caroline A Sabin
- Institute for Global Health, University College London, London, UK
| | - Jose M Miro
- Infectious Diseases Service, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain; CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Adam Trickey
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Suzanne M Ingle
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jonathan A C Sterne
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; NIHR Bristol Biomedical Research Centre, Bristol, UK; Health Data Research UK South-West, Bristol, UK
| | - Miguel A Hernán
- CAUSALab and Department of Epidemiology, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA; Department of Biostatistics, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
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6
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Rein SM, Lampe FC, Ingle SM, Sterne JAC, Trickey A, Gill MJ, Papastamopoulos V, Wittkop L, van der Valk M, Kitchen M, Guest JL, Satre DD, Wandeler G, Galindo P, Castilho J, Crane HM, Smith CJ. All-cause hospitalisation among people living with HIV according to gender, mode of HIV acquisition, ethnicity, and geographical origin in Europe and North America: findings from the ART-CC cohort collaboration. Lancet Public Health 2023; 8:e776-e787. [PMID: 37777287 PMCID: PMC10851157 DOI: 10.1016/s2468-2667(23)00178-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 07/27/2023] [Accepted: 08/01/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND Understanding demographic disparities in hospitalisation is crucial for the identification of vulnerable populations, interventions, and resource planning. METHODS Data were from the Antiretroviral Therapy Cohort Collaboration (ART-CC) on people living with HIV in Europe and North America, followed up between January, 2007 and December, 2020. We investigated differences in all-cause hospitalisation according to gender and mode of HIV acquisition, ethnicity, and combined geographical origin and ethnicity, in people living with HIV on modern combination antiretroviral therapy (cART). Analyses were performed separately for European and North American cohorts. Hospitalisation rates were assessed using negative binomial multilevel regression, adjusted for age, time since cART intitiaion, and calendar year. FINDINGS Among 23 594 people living with HIV in Europe and 9612 in North America, hospitalisation rates per 100 person-years were 16·2 (95% CI 16·0-16·4) and 13·1 (12·8-13·5). Compared with gay, bisexual, and other men who have sex with men, rates were higher for heterosexual men and women, and much higher for men and women who acquired HIV through injection drug use (adjusted incidence rate ratios ranged from 1·2 to 2·5 in Europe and from 1·2 to 3·3 in North America). In both regions, individuals with geographical origin other than the region of study generally had lower hospitalisation rates compared with those with geographical origin of the study country. In North America, Indigenous people and Black or African American individuals had higher rates than White individuals (adjusted incidence rate ratios 1·9 and 1·2), whereas Asian and Hispanic people living with HIV had somewhat lower rates. In Europe there was a lower rate in Asian individuals compared with White individuals. INTERPRETATION Substantial disparities exist in all-cause hospitalisation between demographic groups of people living with HIV in the current cART era in high-income settings, highlighting the need for targeted support. FUNDING Royal Free Charity and the National Institute on Alcohol Abuse and Alcoholism.
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Affiliation(s)
- Sophia M Rein
- CAUSALab and Department of Epidemiology, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA; Institute for Global Health, UCL, London, UK.
| | | | - Suzanne M Ingle
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jonathan A C Sterne
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; NIHR Bristol Biomedical Research Centre, Bristol, UK; Health Data Research UK South-West, Bristol, UK
| | - Adam Trickey
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - M John Gill
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Vasileios Papastamopoulos
- Department of Internal Medicine and Infectious Diseases, Evaggelismos General Hospital, Athens, Greece
| | - Linda Wittkop
- University of Bordeaux, INSERM, Bordeaux Population Health-U1219, CIC1401-EC, Bordeaux, France; CHU de Bordeaux-Bordeaux University Hospital, Service d'information médicale, INSERM, CIC-EC 1401, Bordeaux, Franc; SISTM, INRIA, University of Bordeaux, Talence, France
| | - Marc van der Valk
- Department of Infectious Diseases, Amsterdam Infection and Immunity Institute (AI&II), Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands; Stichting HIV Monitoring, Amsterdam, Netherlands
| | - Maria Kitchen
- Department of Dermatology, Venereology, and Allergology, Medical University of Innsbruck, Innsbruck, Austria
| | - Jodie L Guest
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Derek D Satre
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA; Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Gilles Wandeler
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Switzerland
| | - Pepa Galindo
- Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Jessica Castilho
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Heidi M Crane
- Department of Medicine and Department of Health Services, University of Washington, Seattle, WA, USA
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7
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de Beer ST, Slogrove AL, Eley B, Ingle SM, Jones HE, Phelanyane F, Anderson K, Kalk E, Boulle A, Davies M. Change in HIV-related characteristics of children hospitalised with infectious diseases in Western Cape, South Africa, 2008-2021: a time trend analysis. J Int AIDS Soc 2023; 26 Suppl 4:e26151. [PMID: 37909168 PMCID: PMC10618898 DOI: 10.1002/jia2.26151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 08/15/2023] [Indexed: 11/02/2023] Open
Abstract
INTRODUCTION With the scaling up of vertical HIV transmission prevention programmes, the HIV-related population profile of children in South Africa has shifted. We described temporal changes in HIV-related characteristics of children, aged ≤3 years (up to the third birthday), with infectious disease hospitalisations across the Western Cape province. METHODS We used routinely collected electronic data to identify children born in the Western Cape with infectious disease hospital records for lower respiratory tract infections, diarrhoea, meningitis and tuberculous meningitis, from 2008 to 2021. Linked maternal and child unique identifiers were used to extract pregnancy, HIV-related, laboratory, pharmacy and hospitalisation data. We described temporal changes in child HIV exposure and acquisition status, timing of maternal HIV diagnosis and antiretroviral therapy (ART) start, infant exposure to maternal ART and timing thereof, and maternal CD4 and HIV viral load closest to delivery. We used logistic and multinomial regression to assess changes in characteristics between the Pre-Option B+ (2008-2013), Option B+ (2013-2016) and Universal ART periods (2016-2021). RESULTS Among 52,811 children aged ≤3 years with hospitalisations, the proportion living with HIV dreased from 7.0% (2008) to 1.1% (2021), while those exposed to HIV and uninfected increased from 14.0% (2008) to 16.1% (2021) with a peak of 18.3% in 2017. Among mothers with HIV (n = 9873), the proportion diagnosed with HIV and starting ART before pregnancy increased from 20.2% to 69.2% and 5.8% to 59.0%, respectively, between 2008 and 2021. Children hospitalised during the Universal ART period had eight times higher odds (Odds Ratio: 8.41; 95% CI: 7.36-9.61) of exposure to maternal ART versus children admitted Pre-Option B+. Among mothers of children exposed to HIV and uninfected with CD4 records (n = 7523), the proportion with CD4 <350 cells/μl decreased from 90.6% (2008) to 27.8% (2021). CONCLUSIONS In recent years, among children hospitalised with infectious diseases, there were fewer children with perinatally acquired HIV, while an increased proportion of those without HIV acquisition are exposed to maternal HIV and ART. There is a need to look beyond paediatric HIV prevalence and consider child exposure to HIV and ART among children without HIV, when assessing the HIV epidemic's impact on child health services.
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Affiliation(s)
- Shani T. de Beer
- Centre for Infectious Disease Epidemiology and ResearchSchool of Public HealthUniversity of Cape TownCape TownSouth Africa
- Health Intelligence DirectorateWestern Cape Government HealthCape TownSouth Africa
- Population Health SciencesBristol Medical SchoolUniversity of BristolBristolUK
| | - Amy L. Slogrove
- Department of Paediatrics & Child HealthFaculty of Medicine & Health Sciences, Stellenbosch UniversityWorcesterSouth Africa
| | - Brian Eley
- Paediatric Infectious Diseases UnitRed Cross War Memorial Children's Hospital and the Department of Paediatrics and Child HealthUniversity of Cape TownCape TownSouth Africa
| | - Suzanne M. Ingle
- Population Health SciencesBristol Medical SchoolUniversity of BristolBristolUK
| | - Hayley E. Jones
- Population Health SciencesBristol Medical SchoolUniversity of BristolBristolUK
| | - Florence Phelanyane
- Centre for Infectious Disease Epidemiology and ResearchSchool of Public HealthUniversity of Cape TownCape TownSouth Africa
- Health Intelligence DirectorateWestern Cape Government HealthCape TownSouth Africa
| | - Kim Anderson
- Centre for Infectious Disease Epidemiology and ResearchSchool of Public HealthUniversity of Cape TownCape TownSouth Africa
| | - Emma Kalk
- Centre for Infectious Disease Epidemiology and ResearchSchool of Public HealthUniversity of Cape TownCape TownSouth Africa
| | - Andrew Boulle
- Centre for Infectious Disease Epidemiology and ResearchSchool of Public HealthUniversity of Cape TownCape TownSouth Africa
- Health Intelligence DirectorateWestern Cape Government HealthCape TownSouth Africa
- Division of Public Health MedicineSchool of Public HealthUniversity of Cape TownCape TownSouth Africa
| | - Mary‐Ann Davies
- Centre for Infectious Disease Epidemiology and ResearchSchool of Public HealthUniversity of Cape TownCape TownSouth Africa
- Health Intelligence DirectorateWestern Cape Government HealthCape TownSouth Africa
- Division of Public Health MedicineSchool of Public HealthUniversity of Cape TownCape TownSouth Africa
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8
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Trickey A, Ingle SM, Boyd A, Gill MJ, Grabar S, Jarrin I, Obel N, Touloumi G, Zangerle R, Rauch A, Rentsch CT, Satre DD, Silverberg MJ, Bonnet F, Guest J, Burkholder G, Crane H, Teira R, Berenguer J, Wyen C, Abgrall S, Hessamfar M, Reiss P, d’Arminio Monforte A, McGinnis KA, Sterne JAC, Wittkop L. Contribution of alcohol use in HIV/hepatitis C virus co-infection to all-cause and cause-specific mortality: A collaboration of cohort studies. J Viral Hepat 2023; 30:775-786. [PMID: 37338017 PMCID: PMC10526649 DOI: 10.1111/jvh.13863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/31/2023] [Accepted: 06/02/2023] [Indexed: 06/21/2023]
Abstract
Among persons with HIV (PWH), higher alcohol use and having hepatitis C virus (HCV) are separately associated with increased morbidity and mortality. We investigated whether the association between alcohol use and mortality among PWH is modified by HCV. Data were combined from European and North American cohorts of adult PWH who started antiretroviral therapy (ART). Self-reported alcohol use data, collected in diverse ways between cohorts, were converted to grams/day. Eligible PWH started ART during 2001-2017 and were followed from ART initiation for mortality. Interactions between the associations of baseline alcohol use (0, 0.1-20.0, >20.0 g/day) and HCV status were assessed using multivariable Cox models. Of 58,769 PWH, 29,711 (51%), 23,974 (41%) and 5084 (9%) self-reported alcohol use of 0 g/day, 0.1-20.0 g/day, and > 20.0 g/day, respectively, and 4799 (8%) had HCV at baseline. There were 844 deaths in 37,729 person-years and 2755 deaths in 443,121 person-years among those with and without HCV, respectively. Among PWH without HCV, adjusted hazard ratios (aHRs) for mortality were 1.18 (95% CI: 1.08-1.29) for 0.0 g/day and 1.84 (1.62-2.09) for >20.0 g/day compared with 0.1-20.0 g/day. This J-shaped pattern was absent among those with HCV: aHRs were 1.00 (0.86-1.17) for 0.0 g/day and 1.64 (1.33-2.02) for >20.0 g/day compared with 0.1-20.0 g/day (interaction p < .001). Among PWH without HCV, mortality was higher in both non-drinkers and heavy drinkers compared with moderate alcohol drinkers. Among those with HCV, mortality was higher in heavy drinkers but not non-drinkers, potentially due to differing reasons for not drinking (e.g. illness) between those with and without HCV.
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Affiliation(s)
- Adam Trickey
- Population Health SciencesUniversity of BristolBristolUK
| | | | - Anders Boyd
- Stichting HIV MonitoringAmsterdamThe Netherlands
- Department of Infectious DiseasesPublic Health Service of AmsterdamAmsterdamThe Netherlands
- Amsterdam UMCUniversity of Amsterdam, Infectious DiseasesAmsterdamThe Netherlands
| | - M. John Gill
- South Alberta HIV Clinic, Department of MedicineUniversity of CalgaryCalgaryCanada
| | - Sophie Grabar
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP)ParisFrance
- Department of Public HealthAP‐HP, St Antoine HospitalParisFrance
| | - Inma Jarrin
- National Centre of EpidemiologyCarlos III Health InstituteMadridSpain
- CIBER de Enfermedades InfecciosasInstituto de Salud Carlos III
| | - Niels Obel
- Department of Infectious DiseasesCopenhagen University Hospital, RigshospitaletCopenhagenDenmark
| | - Giota Touloumi
- Department of Hygiene, Epidemiology and Medical Statistics, Medical SchoolNational and Kapodistrian University of AthensAthensGreece
| | - Robert Zangerle
- Austrian HIV Cohort Study (AHIVCOS)Medizinische Universität InnsbruckInnsbruchAustria
| | - Andri Rauch
- Department of Infectious Diseases, InselspitalBern University Hospital, University of BernBernSwitzerland
| | - Christopher T. Rentsch
- Yale School of Medicine and VA Connecticut Healthcare SystemWest HavenConnecticutUSA
- Faculty of Epidemiology and Population HealthLondon School of Hygiene and Tropical MedicineLondonUK
| | - Derek D. Satre
- Department of Psychiatry and Behavioral SciencesWeill Institute for Neurosciences, University of CaliforniaSan FranciscoUSA
- Division of ResearchKaiser Permanente Northern CaliforniaOaklandCaliforniaUSA
| | | | - Fabrice Bonnet
- Institut Bergonié, BPH, U1219, CIC‐EC 1401, INSERM, Univ. BordeauxBordeauxFrance
- CHU de Bordeaux, Service de Médecine Interne et Maladies Infectieuses, INSERMInstitut Bergonié Hôpital St‐André, CIC‐EC 1401BordeauxFrance
| | - Jodie Guest
- Atlanta VA Medical CenterDecaturGeorgiaUSA
- Rollins School of Public Health at Emory UniversityAtlantaGeorgiaUSA
| | | | - Heidi Crane
- Department of MedicineUniversity of WashingtonSeattleWashingtonUSA
| | - Ramon Teira
- Servicio de Medicina InternaHospital Universitario de SierrallanaTorrelavegaSpain
| | - Juan Berenguer
- Hospital General Universitario Gregorio MarañónMadridSpain
| | - Christoph Wyen
- Department I for Internal MedicineUniversity Hospital of CologneCologneGermany
| | - Sophie Abgrall
- APHP, Service de Médecine Interne, Hôpital BéclèreClamartFrance
- CESP, INSERM U1018, Université Paris‐Saclay, UVSQ, Le Kremlin‐BicêtreVillejuifFrance
| | - Mojgan Hessamfar
- Institut Bergonié, BPH, U1219, CIC‐EC 1401, INSERM, Univ. BordeauxBordeauxFrance
- CHU de Bordeaux, Service de Médecine Interne et Maladies Infectieuses, INSERMInstitut Bergonié Hôpital St‐André, CIC‐EC 1401BordeauxFrance
| | - Peter Reiss
- Stichting HIV MonitoringAmsterdamThe Netherlands
- Department of Global HealthAmsterdam University Medical CentersAmsterdamThe Netherlands
- Amsterdam Institute for Global Health and DevelopmentAmsterdamThe Netherlands
| | - Antonella d’Arminio Monforte
- Clinic of Infectious and Tropical Diseases, Department of Health SciencesASST Santi Paolo e Carlo, University HospitalMilanItaly
| | - Kathleen A. McGinnis
- Yale School of Medicine and VA Connecticut Healthcare SystemWest HavenConnecticutUSA
| | - Jonathan A. C. Sterne
- Population Health SciencesUniversity of BristolBristolUK
- NIHR Bristol Biomedical Research CentreBristolUK
- Health Data Research UK South‐WestBristolUK
| | - Linda Wittkop
- Institut Bergonié, BPH, U1219, CIC‐EC 1401, INSERM, Univ. BordeauxBordeauxFrance
- INRIA SISTM TeamTalenceFrance
- CHU de Bordeaux, Service d'information Médicale, INSERMInstitut Bergonié, CIC‐EC 1401BordeauxFrance
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9
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Chalouni M, Trickey A, Ingle SM, Sepuvelda MA, Gonzalez J, Rauch A, Crane HM, Gill MJ, Rebeiro PF, Rockstroh JK, Franco RA, Touloumi G, Neau D, Laguno M, Rappold M, Smit C, Sterne JAC, Wittkop L. Impact of hepatitis C cure on risk of mortality and morbidity in people with HIV after antiretroviral therapy initiation. AIDS 2023; 37:1573-1581. [PMID: 37199601 DOI: 10.1097/qad.0000000000003594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
OBJECTIVE Hepatitis C virus (HCV) co-infection is associated with increased morbidity and mortality in people with HIV (PWH). Sustained virological response (SVR) decreases the risk of HCV-associated morbidity. We compared mortality, risk of AIDS-defining events, and non-AIDS nonliver (NANL) cancers between HCV-co-infected PWH who reached SVR and mono-infected PWH. DESIGN Adult PWH from 21 cohorts in Europe and North America that collected HCV treatment data were eligible if they were HCV-free at the time of ART initiation. METHODS Up to 10 mono-infected PWH were matched (on age, sex, date of ART start, HIV acquisition route, and being followed at the time of SVR) to each HCV-co-infected PWH who reached SVR. Cox models were used to estimate relative hazards (hazard ratio) of all-cause mortality, AIDS-defining events, and NANL cancers after adjustment. RESULTS Among 62 495 PWH, 2756 acquired HCV, of whom 649 reached SVR. For 582 of these, at least one mono-infected PWH could be matched, producing a total of 5062 mono-infected PWH. The estimated hazard ratios comparing HCV-co-infected PWH who reached SVR with mono-infected PWH were 0.29 [95% confidence interval (CI) 0.12-0.73] for mortality, 0.85 [0.42-1.74] for AIDS-defining events, and 1.21 [0.86-1.72] for NANL cancer. CONCLUSION PWH who reached SVR a short time after HCV acquisition were not at higher risk of overall mortality compared with mono-infected PWH. However, the apparent higher risk of NANL cancers in HCV-co-infected PWH who reached SVR after a DAA-based treatment compared with mono-infected PWH, though compatible with a null association, suggests a need for monitoring of those events following SVR.
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Affiliation(s)
- Mathieu Chalouni
- University Bordeaux, INSERM, Institut Bergonié, BPH, U1219, CIC-EC 1401, Bordeaux
- INRIA SISTM Team, Talence, France
| | - Adam Trickey
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Suzanne M Ingle
- Population Health Sciences, University of Bristol, Bristol, UK
| | | | - Juan Gonzalez
- HIV Unit, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | - Andri Rauch
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Heidi M Crane
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - M John Gill
- Department of Medicine, University of Calgary, Alberta, Canada
| | - Peter F Rebeiro
- Department of Medicine & Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | | | - Ricardo A Franco
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Giota Touloumi
- Department of Hygiene, Epidemiology & Medical Statistics, Medical School, National & Kapodistrian University of Athens, Athens, Greece
| | - Didier Neau
- CHU de Bordeaux, Service des Maladies Infectieuses et Tropicales, INSERM, U1219, Pl. Amélie Raba Léon, Bordeaux, France
| | | | - Michaela Rappold
- Department of Dermatology and Venereology, Medical University of Innsbruck
- Austrian HIV Cohort Study, Innsbruck, Austria
| | - Colette Smit
- Stichting HIV Monitoring, Amsterdam, the Netherlands
| | | | - Linda Wittkop
- University Bordeaux, INSERM, Institut Bergonié, BPH, U1219, CIC-EC 1401, Bordeaux
- INRIA SISTM Team, Talence, France
- CHU de Bordeaux, Service d'information médicale, INSERM, Institut Bergonié, CIC-EC 1401, Bordeaux, France
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10
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Ingle SM, Miro JM, May MT, Cain LE, Schwimmer C, Zangerle R, Sambatakou H, Cazanave C, Reiss P, Brandes V, Bucher HC, Sabin C, Vidal F, Obel N, Mocroft A, Wittkop L, d'Arminio Monforte A, Torti C, Mussini C, Furrer H, Konopnicki D, Teira R, Saag MS, Crane HM, Moore RD, Jacobson JM, Mathews WC, Geng E, Eron JJ, Althoff KN, Kroch A, Lang R, Gill MJ, Sterne JAC. Early Antiretroviral Therapy Not Associated With Higher Cryptococcal Meningitis Mortality in People With Human Immunodeficiency Virus in High-Income Countries: An International Collaborative Cohort Study. Clin Infect Dis 2023; 77:64-73. [PMID: 36883578 PMCID: PMC10320049 DOI: 10.1093/cid/ciad122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 12/13/2022] [Accepted: 03/02/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND Randomized controlled trials (RCTs) from low- and middle-income settings suggested that early initiation of antiretroviral therapy (ART) leads to higher mortality rates among people with HIV (PWH) who present with cryptococcal meningitis (CM). There is limited information about the impact of ART timing on mortality rates in similar people in high-income settings. METHODS Data on ART-naive PWH with CM diagnosed from 1994 to 2012 from Europe/North America were pooled from the COHERE, NA-ACCORD, and CNICS HIV cohort collaborations. Follow-up was considered to span from the date of CM diagnosis to earliest of the following: death, last follow-up, or 6 months. We used marginal structural models to mimic an RCT comparing the effects of early (within 14 days of CM) and late (14-56 days after CM) ART on all-cause mortality, adjusting for potential confounders. RESULTS Of 190 participants identified, 33 (17%) died within 6 months. At CM diagnosis, their median age (interquartile range) was 38 (33-44) years; the median CD4+ T-cell count, 19/μL (10-56/μL); and median HIV viral load, 5.3 (4.9-5.6) log10 copies/mL. Most participants (n = 157 [83%]) were male, and 145 (76%) started ART. Mimicking an RCT, with 190 people in each group, there were 13 deaths among participants with an early ART regimen and 20 deaths among those with a late ART regimen. The crude and adjusted hazard ratios comparing late with early ART were 1.28 (95% confidence interval, .64-2.56) and 1.40 (.66-2.95), respectively. CONCLUSIONS We found little evidence that early ART was associated with higher mortality rates among PWH presenting with CM in high-income settings, although confidence intervals were wide.
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Affiliation(s)
- Suzanne M Ingle
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Jose M Miro
- Infectious Diseases Service Hospital Clinic–IDIBAPS, University of Barcelona, Barcelona, Spain
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Margaret T May
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Lauren E Cain
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Global Epidemiology, AbbVie, Chicago, Illinois, USA
| | - Christine Schwimmer
- University of Bordeaux, INSERM, Institut Bergonié, CHU de Bordeaux, CIC-EC 1401, Bordeaux, France
| | - Robert Zangerle
- Department of Dermatology, Venereology, and Allergy, Medical University Innsbruck, Innsbruck, Austria
| | - Helen Sambatakou
- 2nd Department of Internal Medicine, HIV Unit, Medical School, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Charles Cazanave
- Infectious and Tropical Diseases Department, CHU de Bordeaux, Bordeaux, France
| | - Peter Reiss
- Stichting HIV Monitoring, Amsterdam, The Netherlands
| | - Vanessa Brandes
- Department I of Internal Medicine, Division of Infectious Diseases, University of Cologne, Cologne, Germany
| | - Heiner C Bucher
- Basel Institute for Clinical Epidemiology & Biostatistics, Division of Infectious Diseases & Hospital Hygiene, University Hospital Basel, Basel, Switzerland
| | - Caroline Sabin
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, London, United Kingdom
| | - Francesc Vidal
- Infectious Diseases Unit, Hospital Universitari de Tarragona Joan XXIII, IISPV, Universitat Rovira i Virgili, Tarragona, Spain
- CIBER Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
| | - Niels Obel
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Amanda Mocroft
- Centre of Excellence for Health, Immunity and Infections (CHIP) and PERSIMUNE, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Linda Wittkop
- ISPED, INSERM, Bordeaux Population Health Research Center, University of Bordeaux, Bordeaux, France
| | - Antonella d'Arminio Monforte
- Clinic of Infectious and Tropical Diseases, Department of Health Sciences, University of Milan, San Paolo Hospital, Milan, Italy
| | - Carlo Torti
- Department of Surgical and Medical Sciences, University “Magna Graecia,”, Catanzaro, Italy
| | - Cristina Mussini
- Infectious Diseases Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Hansjakob Furrer
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Deborah Konopnicki
- Infectious Diseases Department, Saint-Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Ramon Teira
- Service of Internal Medicine, Hospital Universitario de Sierrallana, Torrelavega, Spain
| | - Michael S Saag
- Center for AIDS Research, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Heidi M Crane
- Division of Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Richard D Moore
- School of Medicine, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - W Chris Mathews
- Department of Medicine, University of California San Diego, San Diego, California, USA
| | - Elvin Geng
- Division of Infectious Diseases, Department of Medicine and the Center for Dissemination and Implementation, Institute for Public Health, Washington University in St Louis, St Louis, Missouri, USA
| | - Joseph J Eron
- Department of Medicine, UNC School of Medicine, Chapel Hill, North Carolina, USA
| | - Keri N Althoff
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Raynell Lang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - M John Gill
- Department of Medicine, University of Calgary, Southern Alberta HIV Clinic, Calgary, Alberta, Canada
| | - Jonathan A C Sterne
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
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Loosli T, Hossmann S, Ingle SM, Okhai H, Kusejko K, Mouton J, Bellecave P, van Sighem A, Stecher M, d’Arminio Monforte A, Gill MJ, Sabin CA, Maartens G, Günthard HF, Sterne JAC, Lessells R, Egger M, Kouyos R. sHIV-1 drug resistance in people on dolutegravir-based ART: Collaborative analysis of cohort studies. medRxiv 2023:2023.04.05.23288183. [PMID: 37066200 PMCID: PMC10104228 DOI: 10.1101/2023.04.05.23288183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Background The widespread use of the integrase strand transfer inhibitor (INSTI) dolutegravir (DTG) in first- and second-line antiretroviral therapy (ART) may facilitate emerging resistance. We combined data from HIV cohorts to examine patterns of drug resistance mutations (DRMs) and identify risk factors for DTG resistance. Methods Eight cohorts from Canada, Europe, and South Africa contributed data on individuals with genotypic resistance testing on DTG-based ART. Resistance levels were categorised using the Stanford algorithm. We identified risk factors for resistance using mixed-effects ordinal logistic regression models. Results We included 750 people with genotypic resistance testing on DTG-based ART between 2013 and 2022. Most had HIV subtype B (N=444, 59·2%) and were treatment-experienced; 134 (17.9%) were on DTG dual and 19 (2.5%) on DTG monotherapy. INSTI DRMs were detected in 100 (13·3%) individuals; 21 (2·8%) had more than one mutation. Most (N=713, 95·1%) were susceptible to DTG, 8 (1·1%) had potential-low, 5 (0·7%) low, 18 (2·4%) intermediate and 6 (0·8%) high-level DTG resistance. The risk of DTG resistance was higher on DTG monotherapy (adjusted odds ratio (aOR) 37·25, 95% CI 11·17 to 124·2) and DTG lamivudine dual therapy (aOR 6·59, 95% CI 1·70 to 25·55) compared to combination ART, and higher in the presence of potential-low/low (aOR 4.62, 95% CI 1.24 to 17.2) or intermediate/high-level (aOR 7·01, 95% CI 2·52 to 19·48) nucleoside reverse transcriptase inhibitors (NRTI) resistance. Viral load on DTG showed a trend towards increased DTG resistance (aOR 1·42, 95% CI 0·92 to 2·19 per standard deviation of log10 area under the viral load curve). Interpretation Among people experiencing virological failure on DTG-based ART, INSTI DRMs were uncommon, and DTG resistance was rare. DTG monotherapy and NRTI resistance substantially increased the risk for DTG resistance, which is of concern, notably in resource-limited settings.
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Affiliation(s)
- Tom Loosli
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Stefanie Hossmann
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Switzerland
| | - Suzanne M. Ingle
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - Hajra Okhai
- Institute for Global Health, University College London, UK
| | - Katharina Kusejko
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Johannes Mouton
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | | | | | - Melanie Stecher
- German Center for Infection Research (DZIF), Partner-Site Cologne-Bonn, Cologne, Germany
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf
| | - Antonella d’Arminio Monforte
- Italian Cohort Naive Antiretrovirals, (ICONA) L’Azienda Socio Sanitaria Territoriale (ASST) Santi Paolo e Carlo, Milano, Italy
| | - M. John Gill
- Southern Alberta Clinic, Calgary, AB, Canada
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Gary Maartens
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Huldrych F. Günthard
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | | | - Richard Lessells
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
- Centre for Infectious Disease Epidemiology and Research, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Matthias Egger
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Switzerland
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
- Centre for Infectious Disease Epidemiology and Research, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Roger Kouyos
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
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12
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Trickey A, Zhang L, Gill MJ, Bonnet F, Burkholder G, Castagna A, Cavassini M, Cichon P, Crane H, Domingo P, Grabar S, Guest J, Obel N, Psichogiou M, Rava M, Reiss P, Rentsch CT, Riera M, Schuettfort G, Silverberg MJ, Smith C, Stecher M, Sterling TR, Ingle SM, Sabin CA, Sterne JAC. Associations of modern initial antiretroviral drug regimens with all-cause mortality in adults with HIV in Europe and North America: a cohort study. Lancet HIV 2022; 9:e404-e413. [PMID: 35659335 PMCID: PMC9647005 DOI: 10.1016/s2352-3018(22)00046-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 01/31/2022] [Accepted: 02/17/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND Over the past decade, antiretroviral therapy (ART) regimens that include integrase strand inhibitors (INSTIs) have become the most commonly used for people with HIV starting ART. Although trials and observational studies have compared virological failure on INSTI-based with other regimens, few data are available on mortality in people with HIV treated with INSTIs in routine care. Therefore, we compared all-cause mortality between different INSTI-based and non-INSTI-based regimens in adults with HIV starting ART from 2013 to 2018. METHODS This cohort study used data on people with HIV in Europe and North America from the Antiretroviral Therapy Cohort Collaboration (ART-CC) and UK Collaborative HIV Cohort (UK CHIC). We studied the most common third antiretroviral drugs (additional to nucleoside reverse transcriptase inhibitor) used from 2013 to 2018: rilpivirine, darunavir, raltegravir, elvitegravir, dolutegravir, efavirenz, and others. Adjusted hazard ratios (aHRs; adjusted for clinical and demographic characteristics, comorbid conditions, and other drugs in the regimen) for mortality were estimated using Cox models stratified by ART start year and cohort, with multiple imputation of missing data. FINDINGS 62 500 ART-naive people with HIV starting ART (12 422 [19·9%] women; median age 38 [IQR 30-48]) were included in the study. 1243 (2·0%) died during 188 952 person-years of follow-up (median 3·0 years [IQR 1·6-4·4]). There was little evidence that mortality rates differed between regimens with dolutegravir, elvitegravir, rilpivirine, darunavir, or efavirenz as the third drug. However, mortality was higher for raltegravir compared with dolutegravir (aHR 1·49, 95% CI 1·15-1·94), elvitegravir (1·86, 1·43-2·42), rilpivirine (1·99, 1·49-2·66), darunavir (1·62, 1·33-1·98), and efavirenz (2·12, 1·60-2·81) regimens. Results were similar for analyses making different assumptions about missing data and consistent across the time periods 2013-15 and 2016-18. Rates of virological suppression were higher for dolutegravir than other third drugs. INTERPRETATION This large study of patients starting ART since the introduction of INSTIs found little evidence that mortality rates differed between most first-line ART regimens; however, raltegravir-based regimens were associated with higher mortality. Although unmeasured confounding cannot be excluded as an explanation for our findings, virological benefits of first-line INSTIs-based ART might not translate to differences in mortality. FUNDING US National Institute on Alcohol Abuse and Alcoholism and UK Medical Research Council.
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Affiliation(s)
- Adam Trickey
- Population Health Sciences, University of Bristol, Bristol, UK.
| | - Lei Zhang
- Population Health Sciences, University of Bristol, Bristol, UK
| | - M John Gill
- Department of Medicine, University of Calgary, South Alberta HIV Clinic, Calgary, AB, Canada
| | - Fabrice Bonnet
- University of Bordeaux, Institut de santé publique, d'épidémiologie et de développement, Institut National de la Santé et de la Recherche Médicale (INSERM) U1219, Bordeaux, France; Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Greer Burkholder
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Antonella Castagna
- Institute of Infectious Diseases, University vita E Salute, Milan, Italy
| | - Matthias Cavassini
- Division of Infectious Diseases, Lausanne University Hospital, Lausanne, Switzerland
| | - Piotr Cichon
- Infectious Diseases Outpatient Clinic, Otto-Wagner Hospital, Vienna, Austria
| | - Heidi Crane
- Division of Infectious Diseases, Department of Medicine University of Washington, Seattle, WA, USA
| | - Pere Domingo
- Department of Infectious Diseases, Santa Creu i Sant Pau Hospital, Barcelona, Spain
| | - Sophie Grabar
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Paris, France; Department of Public Health, AP-HP, St Antoine Hospital, Paris, France
| | - Jodie Guest
- Atlanta Veterans Association Medical Center, Decatur, GA, USA; Rollins School of Public Health at Emory University, Atlanta, GA, USA
| | - Niels Obel
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Mina Psichogiou
- First Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Marta Rava
- Unit AIDS Research Network Cohort, National Center of Epidemiology, Health Institute Carlos III, Madrid, Spain
| | - Peter Reiss
- Stichting HIV Monitoring, Amsterdam, Netherlands; Department of Global Health, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands; Amsterdam Institute for Global Health and Development, Amsterdam, Netherlands
| | - Christopher T Rentsch
- Yale School of Medicine, Yale University, New Haven, CT, USA; VA Connecticut Healthcare System, West Haven, CT, USA; Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Melchor Riera
- Fundación Instituto de Investigación Sanitaria Illes Balears, Infectious Diseases Unit, Hospital Son Espases, Mallorca, Spain
| | - Gundolf Schuettfort
- Infectious Diseases Unit, Medical Center 2, Frankfurt University Hospital, Frankfurt, Germany
| | | | - Colette Smith
- Department of Infection and Population Health, University College London, London, UK
| | - Melanie Stecher
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany; German Center for Infection Research, Partner Site Cologne-Bonn, Cologne, Germany
| | - Timothy R Sterling
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Suzanne M Ingle
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Caroline A Sabin
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, London, UK
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13
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Beynon RA, Ingle SM, Langdon R, May M, Ness A, Martin RM, Suderman M, Ingarfield K, Marioni RE, McCartney DL, Waterboer T, Pawlita M, Relton C, Smith GD, Richmond RC. Epigenetic biomarkers of ageing are predictive of mortality risk in a longitudinal clinical cohort of individuals diagnosed with oropharyngeal cancer. Clin Epigenetics 2022; 14:1. [PMID: 34980250 PMCID: PMC8725548 DOI: 10.1186/s13148-021-01220-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 12/14/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Epigenetic clocks are biomarkers of ageing derived from DNA methylation levels at a subset of CpG sites. The difference between age predicted by these clocks and chronological age, termed "epigenetic age acceleration", has been shown to predict age-related disease and mortality. We aimed to assess the prognostic value of epigenetic age acceleration and a DNA methylation-based mortality risk score with all-cause mortality in a prospective clinical cohort of individuals with head and neck cancer: Head and Neck 5000. We investigated two markers of intrinsic epigenetic age acceleration (IEAAHorvath and IEAAHannum), one marker of extrinsic epigenetic age acceleration (EEAA), one optimised to predict physiological dysregulation (AgeAccelPheno), one optimised to predict lifespan (AgeAccelGrim) and a DNA methylation-based predictor of mortality (ZhangScore). Cox regression models were first used to estimate adjusted hazard ratios (HR) and 95% confidence intervals (CI) for associations of epigenetic age acceleration with all-cause mortality in people with oropharyngeal cancer (n = 408; 105 deaths). The added prognostic value of epigenetic markers compared to a clinical model including age, sex, TNM stage and HPV status was then evaluated. RESULTS IEAAHannum and AgeAccelGrim were associated with mortality risk after adjustment for clinical and lifestyle factors (HRs per standard deviation [SD] increase in age acceleration = 1.30 [95% CI 1.07, 1.57; p = 0.007] and 1.40 [95% CI 1.06, 1.83; p = 0.016], respectively). There was weak evidence that the addition of AgeAccelGrim to the clinical model improved 3-year mortality prediction (area under the receiver operating characteristic curve: 0.80 vs. 0.77; p value for difference = 0.069). CONCLUSION In the setting of a large, clinical cohort of individuals with head and neck cancer, our study demonstrates the potential of epigenetic markers of ageing to enhance survival prediction in people with oropharyngeal cancer, beyond established prognostic factors. Our findings have potential uses in both clinical and non-clinical contexts: to aid treatment planning and improve patient stratification.
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Affiliation(s)
- Rhona A Beynon
- MRC Integrative Epidemiology Unit, University of Bristol, Oakfield House, Bristol, BS8 2BN, UK.
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
| | - Suzanne M Ingle
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Ryan Langdon
- MRC Integrative Epidemiology Unit, University of Bristol, Oakfield House, Bristol, BS8 2BN, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Margaret May
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Andy Ness
- NIHR Bristol Biomedical Research Centre, University Hospitals Bristol and University of Bristol, Bristol, UK
| | - Richard M Martin
- MRC Integrative Epidemiology Unit, University of Bristol, Oakfield House, Bristol, BS8 2BN, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Matthew Suderman
- MRC Integrative Epidemiology Unit, University of Bristol, Oakfield House, Bristol, BS8 2BN, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Kate Ingarfield
- NIHR Bristol Biomedical Research Centre, University Hospitals Bristol and University of Bristol, Bristol, UK
- Centre for Trials Research, Neuadd Meirionnydd, Heath Park Way, Cardiff, UK
- Community Oral Health, University of Glasgow Dental School, Sauchiehall Street, Glasgow, UK
| | - Riccardo E Marioni
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, EH4 2XU, UK
| | - Daniel L McCartney
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, EH4 2XU, UK
| | - Tim Waterboer
- Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Michael Pawlita
- Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Caroline Relton
- MRC Integrative Epidemiology Unit, University of Bristol, Oakfield House, Bristol, BS8 2BN, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - George Davey Smith
- MRC Integrative Epidemiology Unit, University of Bristol, Oakfield House, Bristol, BS8 2BN, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Rebecca C Richmond
- MRC Integrative Epidemiology Unit, University of Bristol, Oakfield House, Bristol, BS8 2BN, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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14
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Pettit AC, Giganti MJ, Ingle SM, May MT, Shepherd BE, Gill MJ, Fätkenheuer G, Abgrall S, Saag MS, Del Amo J, Justice AC, Miro JM, Cavasinni M, Dabis F, Monforte AD, Reiss P, Guest J, Moore D, Shepherd L, Obel N, Crane HM, Smith C, Teira R, Zangerle R, Sterne JA, Sterling TR. Increased non-AIDS mortality among persons with AIDS-defining events after antiretroviral therapy initiation. J Int AIDS Soc 2019; 21. [PMID: 29334197 PMCID: PMC5810321 DOI: 10.1002/jia2.25031] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 11/10/2017] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION HIV-1 infection leads to chronic inflammation and to an increased risk of non-AIDS mortality. Our objective was to determine whether AIDS-defining events (ADEs) were associated with increased overall and cause-specific non-AIDS related mortality after antiretroviral therapy (ART) initiation. METHODS We included HIV treatment-naïve adults from the Antiretroviral Therapy Cohort Collaboration (ART-CC) who initiated ART from 1996 to 2014. Causes of death were assigned using the Coding Causes of Death in HIV (CoDe) protocol. The adjusted hazard ratio (aHR) for overall and cause-specific non-AIDS mortality among those with an ADE (all ADEs, tuberculosis (TB), Pneumocystis jiroveci pneumonia (PJP), and non-Hodgkin's lymphoma (NHL)) compared to those without an ADE was estimated using a marginal structural model. RESULTS The adjusted hazard of overall non-AIDS mortality was higher among those with any ADE compared to those without any ADE (aHR 2.21, 95% confidence interval (CI) 2.00 to 2.43). The adjusted hazard of each of the cause-specific non-AIDS related deaths were higher among those with any ADE compared to those without, except metabolic deaths (malignancy aHR 2.59 (95% CI 2.13 to 3.14), accident/suicide/overdose aHR 1.37 (95% CI 1.05 to 1.79), cardiovascular aHR 1.95 (95% CI 1.54 to 2.48), infection aHR (95% CI 1.68 to 2.81), hepatic aHR 2.09 (95% CI 1.61 to 2.72), respiratory aHR 4.28 (95% CI 2.67 to 6.88), renal aHR 5.81 (95% CI 2.69 to 12.56) and central nervous aHR 1.53 (95% CI 1.18 to 5.44)). The risk of overall and cause-specific non-AIDS mortality differed depending on the specific ADE of interest (TB, PJP, NHL). CONCLUSIONS In this large multi-centre cohort collaboration with standardized assignment of causes of death, non-AIDS mortality was twice as high among patients with an ADE compared to without an ADE. However, non-AIDS related mortality after an ADE depended on the ADE of interest. Although there may be unmeasured confounders, these findings suggest that a common pathway may be independently driving both ADEs and NADE mortality. While prevention of ADEs may reduce subsequent death due to NADEs following ART initiation, modification of risk factors for NADE mortality remains important after ADE survival.
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Affiliation(s)
- April C Pettit
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Mark J Giganti
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Margaret T May
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Bryan E Shepherd
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Michael J Gill
- Division of Infectious Diseases, University of Calgary, Calgary, Canada
| | - Gerd Fätkenheuer
- Department of Internal Medicine, University of Cologne, Cologne, Germany
| | - Sophie Abgrall
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France.,INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
| | - Michael S Saag
- Division of Infectious Disease, Department of Medicine, University of Alabama, Birmingham, AL, USA
| | - Julia Del Amo
- National Epidemiology Center, Carlos III Health Institute, Madrid, Spain
| | - Amy C Justice
- Yale University School of Medicine, New Haven, CT, USA.,VA Connecticut Healthcare System, West Haven, CT, USA
| | - Jose M Miro
- Hospital Clínic- Institut d'Investigacions Biomèdiques Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Matthias Cavasinni
- Service of Infectious Diseases, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - François Dabis
- INSERM U.1218 Bordeaux Population Health, ISPED, Bordeaux University, Bordeaux, France
| | - Antonella D Monforte
- Clinic of Infectious Diseases & Tropical Medicine, San Paolo Hospital, University of Milan, Milan, Italy
| | - Peter Reiss
- Stichting HIV Monitoring, Division of Infectious Diseases, Department of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
| | - Jodie Guest
- HIV Atlanta VA Cohort Study (HAVACS), Atlanta Veterans Affairs Medical Center, Decatur, GA, USA
| | - David Moore
- Division of Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Leah Shepherd
- Research Department of Infection and Population Health, University College London, London, UK
| | - Niels Obel
- Department of Infectious Diseases, Copenhagen University Hospital, Copenhagen, Denmark
| | - Heidi M Crane
- Center for AIDS Research, University of Washington, Seattle, WA, USA
| | - Colette Smith
- Research Department of Infection and Population Health, UCL, London, UK
| | - Ramon Teira
- Unit of Infectious Diseases, Hospital Sierrallana, Torrelavega, Spain
| | | | | | - Timothy R Sterling
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
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15
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Ingle SM, Crane HM, Glass TR, Yip B, Lima VD, Gill MJ, Hanhoff N, Ammassari A, Mugavero MJ, Tate JP, Guest J, Turner NL, May MT, Sterne JAC. Identifying Risk of Viral Failure in Treated HIV-Infected Patients Using Different Measures of Adherence: The Antiretroviral Therapy Cohort Collaboration. J Clin Med 2018; 7:jcm7100328. [PMID: 30301179 PMCID: PMC6209956 DOI: 10.3390/jcm7100328] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 09/25/2018] [Accepted: 09/28/2018] [Indexed: 11/16/2022] Open
Abstract
Adherence to antiretroviral therapy (ART) is critical for successful treatment of Human Immunodeficiency Virus (HIV), but comparisons across settings are difficult because adherence is measured in different ways. We examined utility of different adherence measures for identification of patients at risk of viral failure (VF). Eight cohorts in the ART Cohort Collaboration contributed data from pharmacy refills or self-report questionnaires collected between 1996 and 2013 (N = 11689). For pharmacy data (N = 7156), we examined associations of percentage adherence during the 1st year of ART with VF (>500 copies/mL) at 1 year. For self-report data (N = 4533), we examined 28-day adherence with VF based on closest viral load measure within 6 months after questionnaire date. Since adherence differed markedly by measurement type, we defined different cut-off points for pharmacy (lower <45%, medium 45–99%, higher 100%) and self-report (lower ≤95%, medium 96–99%, higher 100%) data. Adjusted odds ratios (ORs) for VF in lower and medium, compared to higher adherence groups, were 23.04 (95% CI: 18.44–28.78) and 3.84 (3.36–4.39) for pharmacy data. For self-report data, they were 3.19 (2.31–4.40) and 1.08 (0.80–1.46). Both types of measure were strongly associated with VF. Although adherence measurements over longer time-frames are preferable for prediction, they are less useful for intervention.
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Affiliation(s)
- Suzanne M Ingle
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 2PS, UK.
| | - Heidi M Crane
- Clinical Epidemiology and Health Services Research Core, Center for AIDS Research, University of Washington, WA 98104, USA.
| | - Tracy R Glass
- Swiss Tropical and Public Health Institute, CH-4002 Basel, Switzerland.
| | - Benita Yip
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC V6Z 1Y6, Canada.
| | - Viviane D Lima
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC V6Z 1Y6, Canada.
| | - M John Gill
- Division of Infectious Diseases, University of Calgary, Calgary, AB T2N 4N1, Canada.
| | | | - Adriana Ammassari
- Istituto Nazionale Malattie Infettive "L. Spallanzani", IRCCS, 00149 Rome, Italy.
| | - Michael J Mugavero
- Division of Infectious Disease, Department of Medicine, University of Alabama, Birmingham, AL 35294, USA.
| | - Jan P Tate
- Yale University School of Medicine, West Haven, CT 06510, USA.
| | - Jodie Guest
- HIV Atlanta VA Cohort Study (HAVACS), Rollins School of Public Health at Emory University, Atlanta, GA 30322, USA.
| | - Nicholas L Turner
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 2PS, UK.
| | - Margaret T May
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 2PS, UK.
| | - Jonathan A C Sterne
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 2PS, UK.
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16
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Lane I, Bryce A, Ingle SM, Hay AD. Does locally relevant, real-time infection epidemiological data improve clinician management and antimicrobial prescribing in primary care? A systematic review. Fam Pract 2018; 35:542-550. [PMID: 29529261 PMCID: PMC6142716 DOI: 10.1093/fampra/cmy008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Purpose Antimicrobial resistance is a significant threat to public health. Diagnostic uncertainty is a key driver of antimicrobial prescribing. We sought to determine whether locally relevant, real-time syndromic or microbiological infection epidemiology can improve prescribing by reducing diagnostic uncertainty. Methods Eligible studies investigated effects on primary care prescribing for common infections in Organisation For Economic Co-Operation And Development countries. We searched Medline, Embase, Cumulative index to nursing and allied health literature, Web of Science, grey literature sources, thesis databases and trial registries. Results We identified 9548 reports, of which 17 were eligible, reporting 12 studies, of which 3 reported relevant outcomes. The first (observational) showed antibacterial prescribing for upper respiratory infections reduced from 26.4% to 8.6% (P = 0.01). The second (observational) showed antibacterial prescribing reduced during influenza pandemic compared with seasonal influenza periods [odds ratio (OR) 0.72 (95% CI, 0.68 to 0.77), P < 0.001], while antiviral prescribing increased [OR 6.43 (95% CI, 5.02 to 8.25), P < 0.001]. The likelihood of prescribing also decreased as the number of infection cases a physician saw increased in the previous week [OR 0.57 (95% CI, 0.51 to 0.63), P < 0.001 for ≥12 versus ≤1 patient). The third (randomized-controlled trial) showed an absolute reduction in antibacterial prescribing of 5.1% during a period of moderate influenza activity (P < 0.05). We did not find measures of diagnostic certainty, harms or costs. Conclusion There is promising evidence that epidemiological syndromic and microbiological data can reduce primary care antimicrobial prescribing. Future research should use randomized designs of behaviourally informed interventions, investigate costs and harms, and establish mechanisms of behaviour change. PROSPERO registration CRD42016038871.
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Affiliation(s)
- Isabel Lane
- National Institute for Health Research School for Primary Care Research, Centre for Academic Primary Care, University of Bristol, Bristol, UK
| | - Ashley Bryce
- National Institute for Health Research School for Primary Care Research, Centre for Academic Primary Care, University of Bristol, Bristol, UK
| | - Suzanne M Ingle
- The National Institute for Health Research Health Protection Research Unit in Evaluation of Interventions at University of Bristol, Bristol, UK
| | - Alastair D Hay
- National Institute for Health Research School for Primary Care Research, Centre for Academic Primary Care, University of Bristol, Bristol, UK
- The National Institute for Health Research Health Protection Research Unit in Evaluation of Interventions at University of Bristol, Bristol, UK
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17
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Trickey A, May MT, Schommers P, Tate J, Ingle SM, Guest JL, Gill MJ, Zangerle R, Saag M, Reiss P, Monforte AD, Johnson M, Lima VD, Sterling TR, Cavassini M, Wittkop L, Costagliola D, Sterne JAC. CD4:CD8 Ratio and CD8 Count as Prognostic Markers for Mortality in Human Immunodeficiency Virus-Infected Patients on Antiretroviral Therapy: The Antiretroviral Therapy Cohort Collaboration (ART-CC). Clin Infect Dis 2018; 65:959-966. [PMID: 28903507 PMCID: PMC5850630 DOI: 10.1093/cid/cix466] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 05/22/2017] [Indexed: 01/07/2023] Open
Abstract
Background We investigated whether CD4:CD8 ratio and CD8 count were prognostic for all-cause, AIDS, and non-AIDS mortality in virologically suppressed patients with high CD4 count. Methods We used data from 13 European and North American cohorts of human immunodeficiency virus–infected, antiretroviral therapy (ART)–naive adults who started ART during 1996–2010, who were followed from the date they had CD4 count ≥350 cells/μL and were virologically suppressed (baseline). We used stratified Cox models to estimate unadjusted and adjusted (for sex, people who inject drugs, ART initiation year, and baseline age, CD4 count, AIDS, duration of ART) all-cause and cause-specific mortality hazard ratios for tertiles of CD4:CD8 ratio (0–0.40, 0.41–0.64 [reference], >0.64) and CD8 count (0–760, 761–1138 [reference], >1138 cells/μL) and examined the shape of associations using cubic splines. Results During 276526 person-years, 1834 of 49865 patients died (249 AIDS-related; 1076 non-AIDS-defining; 509 unknown/unclassifiable deaths). There was little evidence that CD4:CD8 ratio was prognostic for all-cause mortality after adjustment for other factors: the adjusted hazard ratio (aHR) for lower vs middle tertile was 1.11 (95% confidence interval [CI], 1.00–1.25). The association of CD8 count with all-cause mortality was U-shaped: aHR for higher vs middle tertile was 1.13 (95% CI, 1.01–1.26). AIDS-related mortality declined with increasing CD4:CD8 ratio and decreasing CD8 count. There was little evidence that CD4:CD8 ratio or CD8 count was prognostic for non-AIDS mortality. Conclusions In this large cohort collaboration, the magnitude of adjusted associations of CD4:CD8 ratio or CD8 count with mortality was too small for them to be useful as independent prognostic markers in virally suppressed patients on ART.
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Affiliation(s)
- Adam Trickey
- School of Social and Community Medicine, University of Bristol, United Kingdom
| | - Margaret T May
- School of Social and Community Medicine, University of Bristol, United Kingdom
| | - Philipp Schommers
- Department I for Internal Medicine, University Hospital of Cologne, Germany
| | - Jan Tate
- Yale University School of Medicine, West Haven, Connecticut
| | - Suzanne M Ingle
- School of Social and Community Medicine, University of Bristol, United Kingdom
| | - Jodie L Guest
- HIV Atlanta Veterans Affairs Cohort Study, Atlanta Veterans Affairs Medical Center, Decatur, Georgia
| | - M John Gill
- Division of Infectious Diseases, University of Calgary, Alberta, Canada
| | | | - Mike Saag
- Division of Infectious Disease, Department of Medicine, University of Alabama, Birmingham
| | - Peter Reiss
- Stichting HIV Monitoring, and Division of Infectious Diseases and Department of Global Health, Academic Medical Center, University of Amsterdam, and Amsterdam Institute for Global Health and Development, The Netherlands
| | | | - Margaret Johnson
- Department of HIV Medicine, Royal Free London NHS Foundation Trust, United Kingdom
| | - Viviane D Lima
- British Columbia Centre for Excellence in HIV/AIDS, and Division of AIDS, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Tim R Sterling
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Matthias Cavassini
- Service of Infectious Diseases, Lausanne University Hospital and University of Lausanne, Switzerland
| | - Linda Wittkop
- INSERM, Unit of Epidemiology and Biostatistics, Bordeaux
| | - Dominique Costagliola
- Sorbonne Universités, INSERM, UPMC Université Paris 06, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France
| | - Jonathan A C Sterne
- School of Social and Community Medicine, University of Bristol, United Kingdom
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18
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Cain LE, Saag MS, Petersen M, May MT, Ingle SM, Logan R, Robins JM, Abgrall S, Shepherd BE, Deeks SG, John Gill M, Touloumi G, Vourli G, Dabis F, Vandenhende MA, Reiss P, van Sighem A, Samji H, Hogg RS, Rybniker J, Sabin CA, Jose S, Del Amo J, Moreno S, Rodríguez B, Cozzi-Lepri A, Boswell SL, Stephan C, Pérez-Hoyos S, Jarrin I, Guest JL, D'Arminio Monforte A, Antinori A, Moore R, Campbell CN, Casabona J, Meyer L, Seng R, Phillips AN, Bucher HC, Egger M, Mugavero MJ, Haubrich R, Geng EH, Olson A, Eron JJ, Napravnik S, Kitahata MM, Van Rompaey SE, Teira R, Justice AC, Tate JP, Costagliola D, Sterne JA, Hernán MA. Using observational data to emulate a randomized trial of dynamic treatment-switching strategies: an application to antiretroviral therapy. Int J Epidemiol 2018; 45:2038-2049. [PMID: 26721599 DOI: 10.1093/ije/dyv295] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2015] [Indexed: 11/12/2022] Open
Abstract
Background When a clinical treatment fails or shows suboptimal results, the question of when to switch to another treatment arises. Treatment switching strategies are often dynamic because the time of switching depends on the evolution of an individual's time-varying covariates. Dynamic strategies can be directly compared in randomized trials. For example, HIV-infected individuals receiving antiretroviral therapy could be randomized to switching therapy within 90 days of HIV-1 RNA crossing above a threshold of either 400 copies/ml (tight-control strategy) or 1000 copies/ml (loose-control strategy). Methods We review an approach to emulate a randomized trial of dynamic switching strategies using observational data from the Antiretroviral Therapy Cohort Collaboration, the Centers for AIDS Research Network of Integrated Clinical Systems and the HIV-CAUSAL Collaboration. We estimated the comparative effect of tight-control vs. loose-control strategies on death and AIDS or death via inverse-probability weighting. Results Of 43 803 individuals who initiated an eligible antiretroviral therapy regimen in 2002 or later, 2001 met the baseline inclusion criteria for the mortality analysis and 1641 for the AIDS or death analysis. There were 21 deaths and 33 AIDS or death events in the tight-control group, and 28 deaths and 41 AIDS or death events in the loose-control group. Compared with tight control, the adjusted hazard ratios (95% confidence interval) for loose control were 1.10 (0.73, 1.66) for death, and 1.04 (0.86, 1.27) for AIDS or death. Conclusions Although our effective sample sizes were small and our estimates imprecise, the described methodological approach can serve as an example for future analyses.
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Affiliation(s)
- Lauren E Cain
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Michael S Saag
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Maya Petersen
- Divisions of Biostatistics and Epidemiology, University of California, Berkeley, School of Public Health, Berkeley, CA, USA
| | - Margaret T May
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Suzanne M Ingle
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Roger Logan
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - James M Robins
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Sophie Abgrall
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), F75013, Paris, France.,Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Antoine Béclère, Service de Médecine Interne, Clamart, France
| | - Bryan E Shepherd
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Steven G Deeks
- Positive Health Program, San Francisco General Hospital, San Francisco, CA, USA
| | - M John Gill
- Division of Infectious Diseases, University of Calgary, Calgary, AB, Canada
| | - Giota Touloumi
- Department of Hygiene, Epidemiology and Medical Statistics, Athens University Medical School, Athens, Greece
| | - Georgia Vourli
- Department of Hygiene, Epidemiology and Medical Statistics, Athens University Medical School, Athens, Greece
| | - François Dabis
- INSERM U897, Centre Inserm Epidémiologie et Biostatistique, Université de Bordeaux, and Bordeaux University Hospital, Department of Internal Medicine, Bordeaux, France
| | - Marie-Anne Vandenhende
- INSERM U897, Centre Inserm Epidémiologie et Biostatistique, Université de Bordeaux, and Bordeaux University Hospital, Department of Internal Medicine, Bordeaux, France
| | - Peter Reiss
- Stichting HIV Monitoring, Amsterdam, Netherlands.,Academic Medical Center, Department of Global Health and Division of Infectious Diseases, University of Amsterdam, and Amsterdam Institute for Global Health and Development, Amsterdam, Netherlands
| | | | - Hasina Samji
- Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Robert S Hogg
- Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Jan Rybniker
- 1st Department of Internal Medicine, University of Cologne, D-50937 Cologne, Germany
| | | | | | - Julia Del Amo
- National Centre of Epidemiology, Instituto de Salud Carlos III, Madrid, Spain.,Consorcio de Investigación Biomédica de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Santiago Moreno
- Ramón y Cajal Hospital, IRYCIS, Madrid, Spain.,University of Alcalá de Henares, Madrid, Spain
| | - Benigno Rodríguez
- Division of Infectious Disease, Case Western Reserve University, Cleveland, OH, USA
| | - Alessandro Cozzi-Lepri
- Department of Infection and Population Health; Division of Population Health, University College London, London, UK
| | | | - Christoph Stephan
- HIV Center, Department of Infectious Diseases, University Hospital, Frankfurt, Germany
| | | | - Inma Jarrin
- National Centre of Epidemiology, Instituto de Salud Carlos III, Madrid, Spain.,Consorcio de Investigación Biomédica de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Jodie L Guest
- Rollins School of Public Health at Emory University, Atlanta, GA, USA.,Emory University School of Medicine, Atlanta, GA, USA.,Atlanta Veterans Affairs Medical Center, Decatur, GA, USA
| | - Antonella D'Arminio Monforte
- Clinic of Infectious Diseases and Tropical Medicine, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy
| | - Andrea Antinori
- Istituto Nazionale per le Malattie Infettive Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Richard Moore
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Colin Nj Campbell
- Consorcio de Investigación Biomédica de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Center for Epidemiological Studies on HIV/AIDS and STI of Catalonia (CEEISCAT), Agència Salut Pública de Catalunya (ASPC), Generalitat de Catalunya, Badalona, 08916 Catalonia, Spain
| | - Jordi Casabona
- Consorcio de Investigación Biomédica de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Center for Epidemiological Studies on HIV/AIDS and STI of Catalonia (CEEISCAT), Agència Salut Pública de Catalunya (ASPC), Generalitat de Catalunya, Badalona, 08916 Catalonia, Spain.,Department of Paediatrics, Obstetrics, Gynaecology and Preventive Medicine, Universitat Autònoma de Barcelona, Bellaterra, 08193 Catalonia, Spain
| | - Laurence Meyer
- Université Paris Sud, INSERM CESP U1018, and AP-HP, Hôpital de Bicêtre, Service de Santé Publique, le Kremlin Bicêtre, France
| | - Rémonie Seng
- Université Paris Sud, INSERM CESP U1018, and AP-HP, Hôpital de Bicêtre, Service de Santé Publique, le Kremlin Bicêtre, France
| | | | - Heiner C Bucher
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland
| | - Matthias Egger
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,University of Bern, Institute for Social and Preventive Medicine, Bern, Switzerland
| | | | - Richard Haubrich
- University of California San Diego, CA, USA (Currently Gilead Sciences, Foster City, CA, USA)
| | - Elvin H Geng
- Division of HIV/AIDS, Department of Medicine, University of California, San Francisco, CA, USA
| | - Ashley Olson
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Joseph J Eron
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sonia Napravnik
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Mari M Kitahata
- Department of Medicine, University of Washington, Seattle, WA, USA
| | | | - Ramón Teira
- Unit of Infectious Diseases, Hospital Sierrallana, Torrelavega, Spain
| | - Amy C Justice
- Yale School of Medicine, New Haven, CT, USA.,VA Connecticut Healthcare System, West Haven, CT, USA
| | - Janet P Tate
- Yale School of Medicine, New Haven, CT, USA.,VA Connecticut Healthcare System, West Haven, CT, USA
| | - Dominique Costagliola
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), F75013, Paris, France
| | - Jonathan Ac Sterne
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Miguel A Hernán
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Harvard-MIT Division of Health Sciences and Technology, Boston, MA, USA
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19
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Horner P, Ingle SM, Garrett F, Blee K, Kong F, Muir P, Moi H. Which azithromycin regimen should be used for treating Mycoplasma genitalium? A meta-analysis. Sex Transm Infect 2017; 94:14-20. [PMID: 28717050 DOI: 10.1136/sextrans-2016-053060] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 04/28/2017] [Accepted: 05/06/2017] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND There is increasing evidence that azithromycin 1 g is driving the emergence of macrolide resistance in Mycoplasma genitalium worldwide. We undertook a meta-analysis of M. genitalium treatment studies using azithromycin 1 g single dose and azithromycin 500 mg on day 1 then 250 mg daily for 4 days (5-day regimen) to determine rates of treatment failure and resistance in both regimens. METHODS The online databases PubMed and Medline were searched using terms "Mycoplasma genitalium", "macrolide" or "azithromycin" and "resistance" up to April 2016. Studies were eligible if they: used azithromycin 1 g or 5 days, assessed patients for macrolide resistant genetic mutations prior to treatment and patients who failed were again resistance genotyped. Random effects meta-analysis was used to estimate failure and resistance rates. RESULTS Eight studies were identified totalling 435 patients of whom 82 (18.9%) had received the 5-day regimen. The random effects pooled rate of treatment failure and development of macrolide antimicrobial resistance mutations with azithromycin 1 g was 13.9% (95% CI 7.7% to 20.1%) and 12.0% (7.1% to 16.9%), respectively. Of individuals treated with the 5-day regimen, with no prior doxycycline treatment, fewer (3.7%; 95% CI 0.8% to 10.3%, p=0.012) failed treatment, all of whom developed resistance (p=0.027). CONCLUSION Azithromycin 1 g is associated with high rates of treatment failure and development of macrolide resistance in M. genitalium infection with no pre-existing macrolide mutations. There is moderate but conflicting evidence that the 5-day regimen may be more effective and less likely to cause resistance.
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Affiliation(s)
- Patrick Horner
- School of Social and Community Medicine, University of Bristol, Bristol, UK.,Bristol Sexual Health Services, University Hospitals Bristol NHS Trust, Bristol, UK.,National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Evaluation of Interventions in partnership with Public Health England, University of Bristol, Bristol, UK
| | - Suzanne M Ingle
- School of Social and Community Medicine, University of Bristol, Bristol, UK.,National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Evaluation of Interventions in partnership with Public Health England, University of Bristol, Bristol, UK
| | - Frederick Garrett
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Karla Blee
- Bristol Sexual Health Services, University Hospitals Bristol NHS Trust, Bristol, UK
| | - Fabian Kong
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Peter Muir
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Evaluation of Interventions in partnership with Public Health England, University of Bristol, Bristol, UK.,Public Health Laboratory Bristol, National Infection Service, Public Health England, Bristol, UK
| | - Harald Moi
- Olafia Clinic, Oslo University Hospital, Institute of Medicine, University of Oslo, Oslo, Norway
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20
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Chaintarli K, Ingle SM, Bhattacharya A, Ashiru-Oredope D, Oliver I, Gobin M. Impact of a United Kingdom-wide campaign to tackle antimicrobial resistance on self-reported knowledge and behaviour change. BMC Public Health 2016; 16:393. [PMID: 27177032 PMCID: PMC4866421 DOI: 10.1186/s12889-016-3057-2] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 04/29/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND As part of the 2014 European Antibiotic Awareness Day plans, a new campaign called Antibiotic Guardian (AG) was launched in the United Kingdom, including an online pledge system to increase commitment from healthcare professionals and members of the public to reduce antimicrobial resistance (AMR). The aim of this evaluation was to determine the impact of the campaign on self-reported knowledge and behaviour around AMR. METHODS An online survey was sent to 9016 Antibiotic Guardians (AGs) to assess changes in self-reported knowledge and behaviour (outcomes) following the campaign. Logistic regression models, adjusted for variables including age, sex and pledge group (pledging as member of public or as healthcare professional), were used to estimate associations between outcomes and AG characteristics. RESULTS 2478 AGs responded to the survey (27.5 % response rate) of whom 1696 (68.4 %) pledged as healthcare professionals and 782 (31.6 %) as members of public (similar proportions to the total number of AGs). 96.3 % of all AGs who responded had prior knowledge of AMR. 73.5 % of participants were female and participants were most commonly between 45 and 54 years old. Two thirds (63.4 %) of participants reported always acting according to their pledge. Members of the public were more likely to act in line with their pledge than professionals (Odds Ratio (OR) =3.60, 95 % Confidence Interval (CI): 2.88-4.51). Approximately half of participants (44.5 %) (both healthcare professionals and members of public) reported that they acquired more knowledge about AMR post-campaign. People that were confused about AMR prior to the campaign acquired more knowledge after the campaign (OR = 3.10, 95 % CI: 1.36-7.09). More participants reported a sense of personal responsibility towards tackling AMR post-campaign, increasing from 58.3 % of participants pre-campaign to 70.5 % post-campaign. CONCLUSION This study demonstrated that the campaign increased commitment to tackling AMR in both healthcare professional and member of the public, increased self-reported knowledge and changed self-reported behaviour particularly among people with prior AMR awareness. Online pledge schemes can be an effective and inexpensive way to engage people with the problem of AMR especially among those with prior awareness of the topic.
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Affiliation(s)
- Katerina Chaintarli
- Field Epidemiology Service, Public Health England, Bristol, UK. .,Health Protection Research Unit in Evaluation of Interventions, School of Social and Community Medicine, University of Bristol, Bristol, UK.
| | - Suzanne M Ingle
- Health Protection Research Unit in Evaluation of Interventions, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Alex Bhattacharya
- Antimicrobial Resistance Programme, Public Health England, London, UK
| | | | - Isabel Oliver
- Field Epidemiology Service, Public Health England, Bristol, UK.,Health Protection Research Unit in Evaluation of Interventions, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Maya Gobin
- Field Epidemiology Service, Public Health England, Bristol, UK.,Health Protection Research Unit in Evaluation of Interventions, School of Social and Community Medicine, University of Bristol, Bristol, UK
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21
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Horwood J, Ingle SM, Burton D, Woodman-Bailey A, Horner P, Jeal N. Sexual health risks, service use, and views of rapid point-of-care testing among men who have sex with men attending saunas: a cross-sectional survey. Int J STD AIDS 2015; 27:273-80. [PMID: 25907347 PMCID: PMC4933927 DOI: 10.1177/0956462415580504] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 03/13/2015] [Indexed: 11/30/2022]
Abstract
Guidelines highlight the need to increase HIV testing among men who have sex with men (MSM) and novel point-of-care testing provides new possibilities for delivery of care. However, it is unclear how point-of-care testing should be used to best effect. This study aimed to increase understanding of sexual risk-taking behaviour, service use, and attitudes to point-of-care testing among MSM sauna clients. Data were collected within two saunas for MSM in south west England using a self-completion survey (n = 134). Though this sample of MSM sauna clients are at high risk of acquiring a sexually transmitted infection, the testing frequency among the majority of those reporting unprotected anal intercourse is not in keeping with national guidelines. For almost all participants the introduction of rapid point-of-care testing for both genital and blood-borne infection was likely to increase testing and for the majority NHS specialist services was the preferred setting.
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Affiliation(s)
- Jeremy Horwood
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Suzanne M Ingle
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - David Burton
- University of Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Paddy Horner
- School of Social and Community Medicine, University of Bristol, Bristol, UK Bristol Sexual Health Service, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Nikki Jeal
- School of Social and Community Medicine, University of Bristol, Bristol, UK Bristol Sexual Health Service, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
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22
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Khairullah A, Cousino Klein L, Ingle SM, May MT, Whetzel CA, Susman EJ, Paus T. Testosterone trajectories and reference ranges in a large longitudinal sample of male adolescents. PLoS One 2014; 9:e108838. [PMID: 25268961 PMCID: PMC4182562 DOI: 10.1371/journal.pone.0108838] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 09/05/2014] [Indexed: 01/03/2023] Open
Abstract
PURPOSE Pubertal dynamics plays an important role in physical and psychological development of children and adolescents. We aim to provide reference ranges of plasma testosterone in a large longitudinal sample. Furthermore, we describe a measure of testosterone trajectories during adolescence that can be used in future investigations of development. METHODS We carried out longitudinal measurements of plasma testosterone in 2,216 samples obtained from 513 males (9 to 17 years of age) from the Avon Longitudinal Study of Parents and Children. We used integration of a model fitted to each participant's testosterone trajectory to calculate a measure of average exposure to testosterone over adolescence. We pooled these data with corresponding values reported in the literature to provide a reference range of testosterone levels in males between the ages of 6 and 19 years. RESULTS The average values of total testosterone in the ALSPAC sample range from 0.82 nmol/L (Standard Deviation [SD]: 0.09) at 9 years of age to 16.5 (SD: 2.65) nmol/L at 17 years of age; these values are congruent with other reports in the literature. The average exposure to testosterone is associated with different features of testosterone trajectories such as Peak Testosterone Change, Age at Peak Testosterone Change, and Testosterone at 17 years of age as well as the timing of the growth spurt during puberty. CONCLUSIONS The average exposure to testosterone is a useful measure for future investigations using testosterone trajectories to examine pubertal dynamics.
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Affiliation(s)
- Ammar Khairullah
- Rotman Research Institute and Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Laura Cousino Klein
- Department of Biobehavioral Health and Penn State Institute of the Neurosciences, The Pennsylvania State University, State College, Pennsylvania, United States of America
| | - Suzanne M. Ingle
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Margaret T. May
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Courtney A. Whetzel
- Department of Biobehavioral Health and the Center for Healthy Aging, The Pennsylvania State University, State College, Pennsylvania, United States of America
| | - Elizabeth J. Susman
- Department of Biobehavioral Health, The Pennsylvania State University, State College, Pennsylvania, United States of America
| | - Tomáš Paus
- Rotman Research Institute and Institute of Medical Science, University of Toronto, Toronto, Canada
- * E-mail:
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23
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Boulle A, Schomaker M, May MT, Hogg RS, Shepherd BE, Monge S, Keiser O, Lampe FC, Giddy J, Ndirangu J, Garone D, Fox M, Ingle SM, Reiss P, Dabis F, Costagliola D, Castagna A, Ehren K, Campbell C, Gill MJ, Saag M, Justice AC, Guest J, Crane HM, Egger M, Sterne JAC. Mortality in patients with HIV-1 infection starting antiretroviral therapy in South Africa, Europe, or North America: a collaborative analysis of prospective studies. PLoS Med 2014; 11:e1001718. [PMID: 25203931 PMCID: PMC4159124 DOI: 10.1371/journal.pmed.1001718] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 07/24/2014] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND High early mortality in patients with HIV-1 starting antiretroviral therapy (ART) in sub-Saharan Africa, compared to Europe and North America, is well documented. Longer-term comparisons between settings have been limited by poor ascertainment of mortality in high burden African settings. This study aimed to compare mortality up to four years on ART between South Africa, Europe, and North America. METHODS AND FINDINGS Data from four South African cohorts in which patients lost to follow-up (LTF) could be linked to the national population register to determine vital status were combined with data from Europe and North America. Cumulative mortality, crude and adjusted (for characteristics at ART initiation) mortality rate ratios (relative to South Africa), and predicted mortality rates were described by region at 0-3, 3-6, 6-12, 12-24, and 24-48 months on ART for the period 2001-2010. Of the adults included (30,467 [South Africa], 29,727 [Europe], and 7,160 [North America]), 20,306 (67%), 9,961 (34%), and 824 (12%) were women. Patients began treatment with markedly more advanced disease in South Africa (median CD4 count 102, 213, and 172 cells/µl in South Africa, Europe, and North America, respectively). High early mortality after starting ART in South Africa occurred mainly in patients starting ART with CD4 count <50 cells/µl. Cumulative mortality at 4 years was 16.6%, 4.7%, and 15.3% in South Africa, Europe, and North America, respectively. Mortality was initially much lower in Europe and North America than South Africa, but the differences were reduced or reversed (North America) at longer durations on ART (adjusted rate ratios 0.46, 95% CI 0.37-0.58, and 1.62, 95% CI 1.27-2.05 between 24 and 48 months on ART comparing Europe and North America to South Africa). While bias due to under-ascertainment of mortality was minimised through death registry linkage, residual bias could still be present due to differing approaches to and frequency of linkage. CONCLUSIONS After accounting for under-ascertainment of mortality, with increasing duration on ART, the mortality rate on HIV treatment in South Africa declines to levels comparable to or below those described in participating North American cohorts, while substantially narrowing the differential with the European cohorts. Please see later in the article for the Editors' Summary.
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Affiliation(s)
- Andrew Boulle
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Department of Health, Provincial Government of the Western Cape, Cape Town, South Africa
- * E-mail:
| | - Michael Schomaker
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Margaret T. May
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Robert S. Hogg
- Division of Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Bryan E. Shepherd
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
| | - Susana Monge
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Olivia Keiser
- University of Bern, Institute for Social and Preventive Medicine, Bern, Switzerland
| | - Fiona C. Lampe
- Research Department of Infection and Population Health, UCL Medical School, London, United Kingdom
| | | | - James Ndirangu
- Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Somkhele, South Africa
| | | | - Matthew Fox
- Center for Global Health and Development, Boston University, Boston, Massachusetts, United States of America
| | - Suzanne M. Ingle
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Peter Reiss
- Stichting HIV Monitoring, Amsterdam, The Netherlands
- Department of Global Health and Division of Infectious Diseases, Academic Medical Center, University of Amsterdam, and Amsterdam Institute for Global health and Development, Amsterdam, the Netherlands
| | - Francois Dabis
- INSERM, Centre INSERM U897 “Epidémiologie et Biostatistique”, Bordeaux, France
- Université Bordeaux, Institut de Santé Publique Epidémiologie Développement (ISPED), Bordeaux, France
| | - Dominique Costagliola
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
- INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
| | - Antonella Castagna
- Infectious Diseases Department, San Raffaele Scientific Institute, Milan, Italy
| | - Kathrin Ehren
- First Department of Internal Medicine, University Hospital of Cologne, Germany
| | - Colin Campbell
- Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Institut català d'Oncologia (ICO), Agència Salut Pública de Catalunya (ASPC), Generalitat de Catalunya, Badalona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - M. John Gill
- Division of Infectious Diseases, University of Calgary, Calgary, Canada
| | - Michael Saag
- Division of Infectious Disease, Department of Medicine, University of Alabama, Birmingham, Alabama, United States of America
| | - Amy C. Justice
- Yale University School of Medicine, New Haven, Connecticut, United States of America
- VA Connecticut Healthcare System, West Haven, Connecticut, United States of America
| | - Jodie Guest
- HIV Atlanta VA Cohort Study (HAVACS), Atlanta Veterans Affairs Medical Center, Decatur, Georgia, United States of America
| | - Heidi M. Crane
- Center for AIDS Research, University of Washington, Seattle, Washington, United States of America
| | - Matthias Egger
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- University of Bern, Institute for Social and Preventive Medicine, Bern, Switzerland
| | - Jonathan A. C. Sterne
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
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24
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Ingle SM, May MT, Gill MJ, Mugavero MJ, Lewden C, Abgrall S, Fätkenheuer G, Reiss P, Saag MS, Manzardo C, Grabar S, Bruyand M, Moore D, Mocroft A, Sterling TR, D'Arminio Monforte A, Hernando V, Teira R, Guest J, Cavassini M, Crane HM, Sterne JAC. Impact of risk factors for specific causes of death in the first and subsequent years of antiretroviral therapy among HIV-infected patients. Clin Infect Dis 2014; 59:287-97. [PMID: 24771333 PMCID: PMC4073781 DOI: 10.1093/cid/ciu261] [Citation(s) in RCA: 106] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Among HIV-infected patients who initiated antiretroviral therapy (ART), patterns of cause-specific death varied by ART duration and were strongly related to age, sex, and transmission risk group. Deaths from non-AIDS malignancies were much more frequent than those from cardiovascular disease. Background. Patterns of cause-specific mortality in individuals infected with human immunodeficiency virus type 1 (HIV-1) are changing dramatically in the era of antiretroviral therapy (ART). Methods. Sixteen cohorts from Europe and North America contributed data on adult patients followed from the start of ART. Procedures for coding causes of death were standardized. Estimated hazard ratios (HRs) were adjusted for transmission risk group, sex, age, year of ART initiation, baseline CD4 count, viral load, and AIDS status, before and after the first year of ART. Results. A total of 4237 of 65 121 (6.5%) patients died (median, 4.5 years follow-up). Rates of AIDS death decreased substantially with time since starting ART, but mortality from non-AIDS malignancy increased (rate ratio, 1.04 per year; 95% confidence interval [CI], 1.0–1.1). Higher mortality in men than women during the first year of ART was mostly due to non-AIDS malignancy and liver-related deaths. Associations with age were strongest for cardiovascular disease, heart/vascular, and malignancy deaths. Patients with presumed transmission through injection drug use had higher rates of all causes of death, particularly for liver-related causes (HRs compared with men who have sex with men: 18.1 [95% CI, 6.2–52.7] during the first year of ART and 9.1 [95% CI, 5.8–14.2] thereafter). There was a persistent role of CD4 count at baseline and at 12 months in predicting AIDS, non-AIDS infection, and non-AIDS malignancy deaths. Lack of viral suppression on ART was associated with AIDS, non-AIDS infection, and other causes of death. Conclusions. Better understanding of patterns of and risk factors for cause-specific mortality in the ART era can aid in development of appropriate care for HIV-infected individuals and inform guidelines for risk factor management.
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Affiliation(s)
- Suzanne M Ingle
- School of Social and Community Medicine, University of Bristol, United Kingdom
| | - Margaret T May
- School of Social and Community Medicine, University of Bristol, United Kingdom
| | - M John Gill
- Division of Infectious Diseases, University of Calgary, Canada
| | - Michael J Mugavero
- Division of Infectious Disease, Department of Medicine, University of Alabama, Birmingham
| | - Charlotte Lewden
- INSERM, Centre INSERM U897-Epidemiologie-Biostatistique, Bordeaux Université Bordeaux, Institut de Santé Publique, d'Epidémiologie et de Developpement (ISPED)
| | - Sophie Abgrall
- UPMC Université Paris 06, UMR_S 943 INSERM, UMR_S 943, Paris Service des maladies infectieuses et tropicales, AP-HP, Hôpital Avicenne, Bobigny, France
| | | | - Peter Reiss
- Stichting HIV Monitoring, and Division of Infectious Diseases and Department of Global Health, Amsterdam Institute for Global Health and Development, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Michael S Saag
- Division of Infectious Disease, Department of Medicine, University of Alabama, Birmingham
| | | | - Sophie Grabar
- INSERM, UMR_S 943, Paris AP-HP, Hôpital Cochin, Unité de Biostatistique et Epidémiologie, Paris Université Paris Descartes
| | - Mathias Bruyand
- INSERM, ISPED, Centre Inserm U897-Epidemiologie-Biostatistique, Bordeaux, France
| | - David Moore
- BC Centre for Excellence in HIV/AIDS, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Amanda Mocroft
- Research Department of Infection and Population Health, University College London, United Kingdom
| | | | | | - Victoria Hernando
- Red de Investigación en Sida, Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid CIBER de Epidemiología y Salud Pública, Madrid
| | - Ramon Teira
- Unit of Infectious Diseases, Hospital Sierrallana, Torrelavega, Spain
| | - Jodie Guest
- HIV Atlanta VA Cohort Study, Atlanta Veterans Affairs Medical Center, Decatur, Georgia
| | - Matthias Cavassini
- Service of Infectious Diseases, Lausanne University Hospital and University of Lausanne, Switzerland
| | - Heidi M Crane
- Clinical Epidemiology and Health Services Research Core, Center for AIDS Research, University of Washington, Seattle
| | - Jonathan A C Sterne
- School of Social and Community Medicine, University of Bristol, United Kingdom
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25
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Engsig FN, Zangerle R, Katsarou O, Dabis F, Reiss P, Gill J, Porter K, Sabin C, Riordan A, Fätkenheuer G, Gutiérrez F, Raffi F, Kirk O, Mary-Krause M, Stephan C, de Olalla PG, Guest J, Samji H, Castagna A, d'Arminio Monforte A, Skaletz-Rorowski A, Ramos J, Lapadula G, Mussini C, Force L, Meyer L, Lampe F, Boufassa F, Bucher HC, De Wit S, Burkholder GA, Teira R, Justice AC, Sterling TR, M Crane H, Gerstoft J, Grarup J, May M, Chêne G, Ingle SM, Sterne J, Obel N. Long-term mortality in HIV-positive individuals virally suppressed for >3 years with incomplete CD4 recovery. Clin Infect Dis 2014; 58:1312-21. [PMID: 24457342 DOI: 10.1093/cid/ciu038] [Citation(s) in RCA: 116] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Some human immunodeficiency virus (HIV)-infected individuals initiating combination antiretroviral therapy (cART) with low CD4 counts achieve viral suppression but not CD4 cell recovery. We aimed to identify (1) risk factors for failure to achieve CD4 count >200 cells/µL after 3 years of sustained viral suppression and (2) the association of the achieved CD4 count with subsequent mortality. METHODS We included treated HIV-infected adults from 2 large international HIV cohorts, who had viral suppression (≤500 HIV type 1 RNA copies/mL) for >3 years with CD4 count ≤200 cells/µL at start of the suppressed period. Logistic regression was used to identify risk factors for incomplete CD4 recovery (≤200 cells/µL) and Cox regression to identify associations with mortality. RESULTS Of 5550 eligible individuals, 835 (15%) did not reach a CD4 count >200 cells/µL after 3 years of suppression. Increasing age, lower initial CD4 count, male heterosexual and injection drug use transmission, cART initiation after 1998, and longer time from initiation of cART to start of the virally suppressed period were risk factors for not achieving a CD4 count >200 cells/µL. Individuals with CD4 ≤200 cells/µL after 3 years of viral suppression had substantially increased mortality (adjusted hazard ratio, 2.60; 95% confidence interval, 1.86-3.61) compared with those who achieved CD4 count >200 cells/µL. The increased mortality was seen across different patient groups and for all causes of death. CONCLUSIONS Virally suppressed HIV-positive individuals on cART who do not achieve a CD4 count >200 cells/µL have substantially increased long-term mortality.
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Affiliation(s)
- Frederik N Engsig
- Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital
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26
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Shepherd BE, Jenkins CA, Parrish DD, Glass TR, Cescon A, Masabeu A, Chene G, de Wolf F, Crane HM, Jarrin I, Gill J, del Amo J, Abgrall S, Khaykin P, Lehmann C, Ingle SM, May MT, Sterne JAC, Sterling TR. Higher rates of AIDS during the first year of antiretroviral therapy among migrants: the importance of tuberculosis. AIDS 2013; 27:1321-9. [PMID: 23925379 PMCID: PMC3992322 DOI: 10.1097/qad.0b013e32835faa95] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE In lower-income countries rates of AIDS-defining events (ADEs) and death are high during the first year of combination antiretroviral therapy (ART). We investigated differences between foreign-born (migrant) and native-born (nonmigrant) patients initiating ART in Europe, the US and Canada, and examined rates of the most common ADEs and mortality during the first year of ART. DESIGN Observational cohort study. METHODS We studied HIV-positive adults participating in one of 12 cohorts in the Antiretroviral Therapy Cohort Collaboration (ART-CC). RESULTS Of 48 854 patients, 25.6% were migrants: 16.1% from sub-Saharan Africa, 5.6% Latin America, 2.3% North Africa/Middle East, and 1.6% Asia. Incidence of ADEs during the first year of ART was 60.8 per 1000 person-years: 69.9 for migrants and 57.7 for nonmigrants [crude hazard ratio (HR) 1.18; 95% confidence interval (CI) 1.08-1.29], adjusted HR (for sex, age, CD4, HIV-1 RNA, ART regimen, prior ADE, probable route of infection and year of initiation, and stratified by cohort) 1.21 (95% CI 1.09-1.34). Rates of tuberculosis were substantially higher in migrants than nonmigrants (14.3 vs. 6.3; adjusted HR 1.94; 95% CI 1.53-2.46). In contrast, mortality was higher among nonmigrants than migrants (crude HR 0.71; 95% CI 0.61-0.84), although excess mortality was partially explained by patient characteristics at start of ART (adjusted HR 0.91; 95% CI 0.76-1.09). CONCLUSIONS During the first year of ART, HIV-positive migrants had higher rates of ADEs than nonmigrants. Tuberculosis was the most common ADE among migrants, highlighting the importance of screening for tuberculosis prior to ART initiation in this population.
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27
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May MT, Ingle SM, Costagliola D, Justice AC, de Wolf F, Cavassini M, D'Arminio Monforte A, Casabona J, Hogg RS, Mocroft A, Lampe FC, Dabis F, Fätkenheuer G, Sterling TR, del Amo J, Gill MJ, Crane HM, Saag MS, Guest J, Brodt HR, Sterne JAC. Cohort profile: Antiretroviral Therapy Cohort Collaboration (ART-CC). Int J Epidemiol 2013; 43:691-702. [PMID: 23599235 DOI: 10.1093/ije/dyt010] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The advent of effective combination antiretroviral therapy (ART) in 1996 resulted in fewer patients experiencing clinical events, so that some prognostic analyses of individual cohort studies of human immunodeficiency virus-infected individuals had low statistical power. Because of this, the Antiretroviral Therapy Cohort Collaboration (ART-CC) of HIV cohort studies in Europe and North America was established in 2000, with the aim of studying the prognosis for clinical events in acquired immune deficiency syndrome (AIDS) and the mortality of adult patients treated for HIV-1 infection. In 2002, the ART-CC collected data on more than 12,000 patients in 13 cohorts who had begun combination ART between 1995 and 2001. Subsequent updates took place in 2004, 2006, 2008, and 2010. The ART-CC data base now includes data on more than 70,000 patients participating in 19 cohorts who began treatment before the end of 2009. Data are collected on patient demographics (e.g. sex, age, assumed transmission group, race/ethnicity, geographical origin), HIV biomarkers (e.g. CD4 cell count, plasma viral load of HIV-1), ART regimen, dates and types of AIDS events, and dates and causes of death. In recent years, additional data on co-infections such as hepatitis C; risk factors such as smoking, alcohol and drug use; non-HIV biomarkers such as haemoglobin and liver enzymes; and adherence to ART have been collected whenever available. The data remain the property of the contributing cohorts, whose representatives manage the ART-CC via the steering committee of the Collaboration. External collaboration is welcomed. Details of contacts are given on the ART-CC website (www.art-cohort-collaboration.org).
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Affiliation(s)
- Margaret T May
- School of Social and Community Medicine, University of Bristol, Bristol, UK, UPMC Univ Paris 06, UMR_S 943, F-75013, Paris, France; INSERM, UMR_S 943, F-75013, Paris, France; AP-HP, Hôpital Pitié-Salpétrière, Service des maladies infectieuses et tropicales, F-75013, Paris, France, Yale University School of Medicine, New Haven, CT, USA, VA Connecticut Healthcare System, West Haven, CT, USA, Academisch Medisch Centrum bij de Universiteit van Amsterdam, Amsterdam, The Netherlands, University Hospital Lausanne, Lausanne, Switzerland, Clinic of Infectious Diseases & Tropical Medicine, San Paolo Hospital, University of Milan, Italy, Centre d'Estudis Epidemiològics sobre ITS/VIH/SIDA de Catalunya, Badalona, Spain, Division of Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada, Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada, Research Department of Infection and Population Health, UCL Medical School, London, UK, INSERM U.897, ISPED, Université Bordeaux, Bordeaux, France, Department of Internal Medicine University of Cologne, DE, Vanderbilt University School of Medicine, Nashville, TN, USA, National Epidemiology Center. Carlos III Health Institute, Madrid, Spain, Division of Infectious Diseases, University of Calgary, Calgary, Canada, University of Washington School of Medicine, Seattle, WA, USA, Division of Infectious Disease, Department of Medicine, University of Alabama, Birmingham, USA, HIV Atlanta VA Cohort Study (HAVACS), Atlanta Veterans Affairs Medical Center, Decatur, GA, USA and Johann Wolfgang Goethe-Universität, HIVCENTER, Frankfurt, Germany
| | - Suzanne M Ingle
- School of Social and Community Medicine, University of Bristol, Bristol, UK, UPMC Univ Paris 06, UMR_S 943, F-75013, Paris, France; INSERM, UMR_S 943, F-75013, Paris, France; AP-HP, Hôpital Pitié-Salpétrière, Service des maladies infectieuses et tropicales, F-75013, Paris, France, Yale University School of Medicine, New Haven, CT, USA, VA Connecticut Healthcare System, West Haven, CT, USA, Academisch Medisch Centrum bij de Universiteit van Amsterdam, Amsterdam, The Netherlands, University Hospital Lausanne, Lausanne, Switzerland, Clinic of Infectious Diseases & Tropical Medicine, San Paolo Hospital, University of Milan, Italy, Centre d'Estudis Epidemiològics sobre ITS/VIH/SIDA de Catalunya, Badalona, Spain, Division of Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada, Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada, Research Department of Infection and Population Health, UCL Medical School, London, UK, INSERM U.897, ISPED, Université Bordeaux, Bordeaux, France, Department of Internal Medicine University of Cologne, DE, Vanderbilt University School of Medicine, Nashville, TN, USA, National Epidemiology Center. Carlos III Health Institute, Madrid, Spain, Division of Infectious Diseases, University of Calgary, Calgary, Canada, University of Washington School of Medicine, Seattle, WA, USA, Division of Infectious Disease, Department of Medicine, University of Alabama, Birmingham, USA, HIV Atlanta VA Cohort Study (HAVACS), Atlanta Veterans Affairs Medical Center, Decatur, GA, USA and Johann Wolfgang Goethe-Universität, HIVCENTER, Frankfurt, Germany
| | - Dominique Costagliola
- School of Social and Community Medicine, University of Bristol, Bristol, UK, UPMC Univ Paris 06, UMR_S 943, F-75013, Paris, France; INSERM, UMR_S 943, F-75013, Paris, France; AP-HP, Hôpital Pitié-Salpétrière, Service des maladies infectieuses et tropicales, F-75013, Paris, France, Yale University School of Medicine, New Haven, CT, USA, VA Connecticut Healthcare System, West Haven, CT, USA, Academisch Medisch Centrum bij de Universiteit van Amsterdam, Amsterdam, The Netherlands, University Hospital Lausanne, Lausanne, Switzerland, Clinic of Infectious Diseases & Tropical Medicine, San Paolo Hospital, University of Milan, Italy, Centre d'Estudis Epidemiològics sobre ITS/VIH/SIDA de Catalunya, Badalona, Spain, Division of Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada, Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada, Research Department of Infection and Population Health, UCL Medical School, London, UK, INSERM U.897, ISPED, Université Bordeaux, Bordeaux, France, Department of Internal Medicine University of Cologne, DE, Vanderbilt University School of Medicine, Nashville, TN, USA, National Epidemiology Center. Carlos III Health Institute, Madrid, Spain, Division of Infectious Diseases, University of Calgary, Calgary, Canada, University of Washington School of Medicine, Seattle, WA, USA, Division of Infectious Disease, Department of Medicine, University of Alabama, Birmingham, USA, HIV Atlanta VA Cohort Study (HAVACS), Atlanta Veterans Affairs Medical Center, Decatur, GA, USA and Johann Wolfgang Goethe-Universität, HIVCENTER, Frankfurt, Germany
| | - Amy C Justice
- School of Social and Community Medicine, University of Bristol, Bristol, UK, UPMC Univ Paris 06, UMR_S 943, F-75013, Paris, France; INSERM, UMR_S 943, F-75013, Paris, France; AP-HP, Hôpital Pitié-Salpétrière, Service des maladies infectieuses et tropicales, F-75013, Paris, France, Yale University School of Medicine, New Haven, CT, USA, VA Connecticut Healthcare System, West Haven, CT, USA, Academisch Medisch Centrum bij de Universiteit van Amsterdam, Amsterdam, The Netherlands, University Hospital Lausanne, Lausanne, Switzerland, Clinic of Infectious Diseases & Tropical Medicine, San Paolo Hospital, University of Milan, Italy, Centre d'Estudis Epidemiològics sobre ITS/VIH/SIDA de Catalunya, Badalona, Spain, Division of Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada, Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada, Research Department of Infection and Population Health, UCL Medical School, London, UK, INSERM U.897, ISPED, Université Bordeaux, Bordeaux, France, Department of Internal Medicine University of Cologne, DE, Vanderbilt University School of Medicine, Nashville, TN, USA, National Epidemiology Center. Carlos III Health Institute, Madrid, Spain, Division of Infectious Diseases, University of Calgary, Calgary, Canada, University of Washington School of Medicine, Seattle, WA, USA, Division of Infectious Disease, Department of Medicine, University of Alabama, Birmingham, USA, HIV Atlanta VA Cohort Study (HAVACS), Atlanta Veterans Affairs Medical Center, Decatur, GA, USA and Johann Wolfgang Goethe-Universität, HIVCENTER, Frankfurt, GermanySchool of Social and Community Medicine, University of Bristol, Bristol, UK, UPMC Univ Paris 06, UMR_S 943, F-75013, Paris, France; INSERM, UMR_S 943, F-75013, Paris, France; AP-HP, Hôpital Pitié-Salpétrière, Service des maladies infectieuses et tropicales, F-75013, Paris, France, Yale University School of Medicine, New Haven, CT, USA, VA Co
| | - Frank de Wolf
- School of Social and Community Medicine, University of Bristol, Bristol, UK, UPMC Univ Paris 06, UMR_S 943, F-75013, Paris, France; INSERM, UMR_S 943, F-75013, Paris, France; AP-HP, Hôpital Pitié-Salpétrière, Service des maladies infectieuses et tropicales, F-75013, Paris, France, Yale University School of Medicine, New Haven, CT, USA, VA Connecticut Healthcare System, West Haven, CT, USA, Academisch Medisch Centrum bij de Universiteit van Amsterdam, Amsterdam, The Netherlands, University Hospital Lausanne, Lausanne, Switzerland, Clinic of Infectious Diseases & Tropical Medicine, San Paolo Hospital, University of Milan, Italy, Centre d'Estudis Epidemiològics sobre ITS/VIH/SIDA de Catalunya, Badalona, Spain, Division of Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada, Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada, Research Department of Infection and Population Health, UCL Medical School, London, UK, INSERM U.897, ISPED, Université Bordeaux, Bordeaux, France, Department of Internal Medicine University of Cologne, DE, Vanderbilt University School of Medicine, Nashville, TN, USA, National Epidemiology Center. Carlos III Health Institute, Madrid, Spain, Division of Infectious Diseases, University of Calgary, Calgary, Canada, University of Washington School of Medicine, Seattle, WA, USA, Division of Infectious Disease, Department of Medicine, University of Alabama, Birmingham, USA, HIV Atlanta VA Cohort Study (HAVACS), Atlanta Veterans Affairs Medical Center, Decatur, GA, USA and Johann Wolfgang Goethe-Universität, HIVCENTER, Frankfurt, Germany
| | - Matthias Cavassini
- School of Social and Community Medicine, University of Bristol, Bristol, UK, UPMC Univ Paris 06, UMR_S 943, F-75013, Paris, France; INSERM, UMR_S 943, F-75013, Paris, France; AP-HP, Hôpital Pitié-Salpétrière, Service des maladies infectieuses et tropicales, F-75013, Paris, France, Yale University School of Medicine, New Haven, CT, USA, VA Connecticut Healthcare System, West Haven, CT, USA, Academisch Medisch Centrum bij de Universiteit van Amsterdam, Amsterdam, The Netherlands, University Hospital Lausanne, Lausanne, Switzerland, Clinic of Infectious Diseases & Tropical Medicine, San Paolo Hospital, University of Milan, Italy, Centre d'Estudis Epidemiològics sobre ITS/VIH/SIDA de Catalunya, Badalona, Spain, Division of Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada, Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada, Research Department of Infection and Population Health, UCL Medical School, London, UK, INSERM U.897, ISPED, Université Bordeaux, Bordeaux, France, Department of Internal Medicine University of Cologne, DE, Vanderbilt University School of Medicine, Nashville, TN, USA, National Epidemiology Center. Carlos III Health Institute, Madrid, Spain, Division of Infectious Diseases, University of Calgary, Calgary, Canada, University of Washington School of Medicine, Seattle, WA, USA, Division of Infectious Disease, Department of Medicine, University of Alabama, Birmingham, USA, HIV Atlanta VA Cohort Study (HAVACS), Atlanta Veterans Affairs Medical Center, Decatur, GA, USA and Johann Wolfgang Goethe-Universität, HIVCENTER, Frankfurt, Germany
| | - Antonella D'Arminio Monforte
- School of Social and Community Medicine, University of Bristol, Bristol, UK, UPMC Univ Paris 06, UMR_S 943, F-75013, Paris, France; INSERM, UMR_S 943, F-75013, Paris, France; AP-HP, Hôpital Pitié-Salpétrière, Service des maladies infectieuses et tropicales, F-75013, Paris, France, Yale University School of Medicine, New Haven, CT, USA, VA Connecticut Healthcare System, West Haven, CT, USA, Academisch Medisch Centrum bij de Universiteit van Amsterdam, Amsterdam, The Netherlands, University Hospital Lausanne, Lausanne, Switzerland, Clinic of Infectious Diseases & Tropical Medicine, San Paolo Hospital, University of Milan, Italy, Centre d'Estudis Epidemiològics sobre ITS/VIH/SIDA de Catalunya, Badalona, Spain, Division of Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada, Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada, Research Department of Infection and Population Health, UCL Medical School, London, UK, INSERM U.897, ISPED, Université Bordeaux, Bordeaux, France, Department of Internal Medicine University of Cologne, DE, Vanderbilt University School of Medicine, Nashville, TN, USA, National Epidemiology Center. Carlos III Health Institute, Madrid, Spain, Division of Infectious Diseases, University of Calgary, Calgary, Canada, University of Washington School of Medicine, Seattle, WA, USA, Division of Infectious Disease, Department of Medicine, University of Alabama, Birmingham, USA, HIV Atlanta VA Cohort Study (HAVACS), Atlanta Veterans Affairs Medical Center, Decatur, GA, USA and Johann Wolfgang Goethe-Universität, HIVCENTER, Frankfurt, Germany
| | - Jordi Casabona
- School of Social and Community Medicine, University of Bristol, Bristol, UK, UPMC Univ Paris 06, UMR_S 943, F-75013, Paris, France; INSERM, UMR_S 943, F-75013, Paris, France; AP-HP, Hôpital Pitié-Salpétrière, Service des maladies infectieuses et tropicales, F-75013, Paris, France, Yale University School of Medicine, New Haven, CT, USA, VA Connecticut Healthcare System, West Haven, CT, USA, Academisch Medisch Centrum bij de Universiteit van Amsterdam, Amsterdam, The Netherlands, University Hospital Lausanne, Lausanne, Switzerland, Clinic of Infectious Diseases & Tropical Medicine, San Paolo Hospital, University of Milan, Italy, Centre d'Estudis Epidemiològics sobre ITS/VIH/SIDA de Catalunya, Badalona, Spain, Division of Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada, Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada, Research Department of Infection and Population Health, UCL Medical School, London, UK, INSERM U.897, ISPED, Université Bordeaux, Bordeaux, France, Department of Internal Medicine University of Cologne, DE, Vanderbilt University School of Medicine, Nashville, TN, USA, National Epidemiology Center. Carlos III Health Institute, Madrid, Spain, Division of Infectious Diseases, University of Calgary, Calgary, Canada, University of Washington School of Medicine, Seattle, WA, USA, Division of Infectious Disease, Department of Medicine, University of Alabama, Birmingham, USA, HIV Atlanta VA Cohort Study (HAVACS), Atlanta Veterans Affairs Medical Center, Decatur, GA, USA and Johann Wolfgang Goethe-Universität, HIVCENTER, Frankfurt, Germany
| | - Robert S Hogg
- School of Social and Community Medicine, University of Bristol, Bristol, UK, UPMC Univ Paris 06, UMR_S 943, F-75013, Paris, France; INSERM, UMR_S 943, F-75013, Paris, France; AP-HP, Hôpital Pitié-Salpétrière, Service des maladies infectieuses et tropicales, F-75013, Paris, France, Yale University School of Medicine, New Haven, CT, USA, VA Connecticut Healthcare System, West Haven, CT, USA, Academisch Medisch Centrum bij de Universiteit van Amsterdam, Amsterdam, The Netherlands, University Hospital Lausanne, Lausanne, Switzerland, Clinic of Infectious Diseases & Tropical Medicine, San Paolo Hospital, University of Milan, Italy, Centre d'Estudis Epidemiològics sobre ITS/VIH/SIDA de Catalunya, Badalona, Spain, Division of Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada, Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada, Research Department of Infection and Population Health, UCL Medical School, London, UK, INSERM U.897, ISPED, Université Bordeaux, Bordeaux, France, Department of Internal Medicine University of Cologne, DE, Vanderbilt University School of Medicine, Nashville, TN, USA, National Epidemiology Center. Carlos III Health Institute, Madrid, Spain, Division of Infectious Diseases, University of Calgary, Calgary, Canada, University of Washington School of Medicine, Seattle, WA, USA, Division of Infectious Disease, Department of Medicine, University of Alabama, Birmingham, USA, HIV Atlanta VA Cohort Study (HAVACS), Atlanta Veterans Affairs Medical Center, Decatur, GA, USA and Johann Wolfgang Goethe-Universität, HIVCENTER, Frankfurt, GermanySchool of Social and Community Medicine, University of Bristol, Bristol, UK, UPMC Univ Paris 06, UMR_S 943, F-75013, Paris, France; INSERM, UMR_S 943, F-75013, Paris, France; AP-HP, Hôpital Pitié-Salpétrière, Service des maladies infectieuses et tropicales, F-75013, Paris, France, Yale University School of Medicine, New Haven, CT, USA, VA Co
| | - Amanda Mocroft
- School of Social and Community Medicine, University of Bristol, Bristol, UK, UPMC Univ Paris 06, UMR_S 943, F-75013, Paris, France; INSERM, UMR_S 943, F-75013, Paris, France; AP-HP, Hôpital Pitié-Salpétrière, Service des maladies infectieuses et tropicales, F-75013, Paris, France, Yale University School of Medicine, New Haven, CT, USA, VA Connecticut Healthcare System, West Haven, CT, USA, Academisch Medisch Centrum bij de Universiteit van Amsterdam, Amsterdam, The Netherlands, University Hospital Lausanne, Lausanne, Switzerland, Clinic of Infectious Diseases & Tropical Medicine, San Paolo Hospital, University of Milan, Italy, Centre d'Estudis Epidemiològics sobre ITS/VIH/SIDA de Catalunya, Badalona, Spain, Division of Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada, Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada, Research Department of Infection and Population Health, UCL Medical School, London, UK, INSERM U.897, ISPED, Université Bordeaux, Bordeaux, France, Department of Internal Medicine University of Cologne, DE, Vanderbilt University School of Medicine, Nashville, TN, USA, National Epidemiology Center. Carlos III Health Institute, Madrid, Spain, Division of Infectious Diseases, University of Calgary, Calgary, Canada, University of Washington School of Medicine, Seattle, WA, USA, Division of Infectious Disease, Department of Medicine, University of Alabama, Birmingham, USA, HIV Atlanta VA Cohort Study (HAVACS), Atlanta Veterans Affairs Medical Center, Decatur, GA, USA and Johann Wolfgang Goethe-Universität, HIVCENTER, Frankfurt, Germany
| | - Fiona C Lampe
- School of Social and Community Medicine, University of Bristol, Bristol, UK, UPMC Univ Paris 06, UMR_S 943, F-75013, Paris, France; INSERM, UMR_S 943, F-75013, Paris, France; AP-HP, Hôpital Pitié-Salpétrière, Service des maladies infectieuses et tropicales, F-75013, Paris, France, Yale University School of Medicine, New Haven, CT, USA, VA Connecticut Healthcare System, West Haven, CT, USA, Academisch Medisch Centrum bij de Universiteit van Amsterdam, Amsterdam, The Netherlands, University Hospital Lausanne, Lausanne, Switzerland, Clinic of Infectious Diseases & Tropical Medicine, San Paolo Hospital, University of Milan, Italy, Centre d'Estudis Epidemiològics sobre ITS/VIH/SIDA de Catalunya, Badalona, Spain, Division of Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada, Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada, Research Department of Infection and Population Health, UCL Medical School, London, UK, INSERM U.897, ISPED, Université Bordeaux, Bordeaux, France, Department of Internal Medicine University of Cologne, DE, Vanderbilt University School of Medicine, Nashville, TN, USA, National Epidemiology Center. Carlos III Health Institute, Madrid, Spain, Division of Infectious Diseases, University of Calgary, Calgary, Canada, University of Washington School of Medicine, Seattle, WA, USA, Division of Infectious Disease, Department of Medicine, University of Alabama, Birmingham, USA, HIV Atlanta VA Cohort Study (HAVACS), Atlanta Veterans Affairs Medical Center, Decatur, GA, USA and Johann Wolfgang Goethe-Universität, HIVCENTER, Frankfurt, Germany
| | - François Dabis
- School of Social and Community Medicine, University of Bristol, Bristol, UK, UPMC Univ Paris 06, UMR_S 943, F-75013, Paris, France; INSERM, UMR_S 943, F-75013, Paris, France; AP-HP, Hôpital Pitié-Salpétrière, Service des maladies infectieuses et tropicales, F-75013, Paris, France, Yale University School of Medicine, New Haven, CT, USA, VA Connecticut Healthcare System, West Haven, CT, USA, Academisch Medisch Centrum bij de Universiteit van Amsterdam, Amsterdam, The Netherlands, University Hospital Lausanne, Lausanne, Switzerland, Clinic of Infectious Diseases & Tropical Medicine, San Paolo Hospital, University of Milan, Italy, Centre d'Estudis Epidemiològics sobre ITS/VIH/SIDA de Catalunya, Badalona, Spain, Division of Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada, Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada, Research Department of Infection and Population Health, UCL Medical School, London, UK, INSERM U.897, ISPED, Université Bordeaux, Bordeaux, France, Department of Internal Medicine University of Cologne, DE, Vanderbilt University School of Medicine, Nashville, TN, USA, National Epidemiology Center. Carlos III Health Institute, Madrid, Spain, Division of Infectious Diseases, University of Calgary, Calgary, Canada, University of Washington School of Medicine, Seattle, WA, USA, Division of Infectious Disease, Department of Medicine, University of Alabama, Birmingham, USA, HIV Atlanta VA Cohort Study (HAVACS), Atlanta Veterans Affairs Medical Center, Decatur, GA, USA and Johann Wolfgang Goethe-Universität, HIVCENTER, Frankfurt, Germany
| | - Gerd Fätkenheuer
- School of Social and Community Medicine, University of Bristol, Bristol, UK, UPMC Univ Paris 06, UMR_S 943, F-75013, Paris, France; INSERM, UMR_S 943, F-75013, Paris, France; AP-HP, Hôpital Pitié-Salpétrière, Service des maladies infectieuses et tropicales, F-75013, Paris, France, Yale University School of Medicine, New Haven, CT, USA, VA Connecticut Healthcare System, West Haven, CT, USA, Academisch Medisch Centrum bij de Universiteit van Amsterdam, Amsterdam, The Netherlands, University Hospital Lausanne, Lausanne, Switzerland, Clinic of Infectious Diseases & Tropical Medicine, San Paolo Hospital, University of Milan, Italy, Centre d'Estudis Epidemiològics sobre ITS/VIH/SIDA de Catalunya, Badalona, Spain, Division of Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada, Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada, Research Department of Infection and Population Health, UCL Medical School, London, UK, INSERM U.897, ISPED, Université Bordeaux, Bordeaux, France, Department of Internal Medicine University of Cologne, DE, Vanderbilt University School of Medicine, Nashville, TN, USA, National Epidemiology Center. Carlos III Health Institute, Madrid, Spain, Division of Infectious Diseases, University of Calgary, Calgary, Canada, University of Washington School of Medicine, Seattle, WA, USA, Division of Infectious Disease, Department of Medicine, University of Alabama, Birmingham, USA, HIV Atlanta VA Cohort Study (HAVACS), Atlanta Veterans Affairs Medical Center, Decatur, GA, USA and Johann Wolfgang Goethe-Universität, HIVCENTER, Frankfurt, Germany
| | - Timothy R Sterling
- School of Social and Community Medicine, University of Bristol, Bristol, UK, UPMC Univ Paris 06, UMR_S 943, F-75013, Paris, France; INSERM, UMR_S 943, F-75013, Paris, France; AP-HP, Hôpital Pitié-Salpétrière, Service des maladies infectieuses et tropicales, F-75013, Paris, France, Yale University School of Medicine, New Haven, CT, USA, VA Connecticut Healthcare System, West Haven, CT, USA, Academisch Medisch Centrum bij de Universiteit van Amsterdam, Amsterdam, The Netherlands, University Hospital Lausanne, Lausanne, Switzerland, Clinic of Infectious Diseases & Tropical Medicine, San Paolo Hospital, University of Milan, Italy, Centre d'Estudis Epidemiològics sobre ITS/VIH/SIDA de Catalunya, Badalona, Spain, Division of Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada, Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada, Research Department of Infection and Population Health, UCL Medical School, London, UK, INSERM U.897, ISPED, Université Bordeaux, Bordeaux, France, Department of Internal Medicine University of Cologne, DE, Vanderbilt University School of Medicine, Nashville, TN, USA, National Epidemiology Center. Carlos III Health Institute, Madrid, Spain, Division of Infectious Diseases, University of Calgary, Calgary, Canada, University of Washington School of Medicine, Seattle, WA, USA, Division of Infectious Disease, Department of Medicine, University of Alabama, Birmingham, USA, HIV Atlanta VA Cohort Study (HAVACS), Atlanta Veterans Affairs Medical Center, Decatur, GA, USA and Johann Wolfgang Goethe-Universität, HIVCENTER, Frankfurt, Germany
| | - Julia del Amo
- School of Social and Community Medicine, University of Bristol, Bristol, UK, UPMC Univ Paris 06, UMR_S 943, F-75013, Paris, France; INSERM, UMR_S 943, F-75013, Paris, France; AP-HP, Hôpital Pitié-Salpétrière, Service des maladies infectieuses et tropicales, F-75013, Paris, France, Yale University School of Medicine, New Haven, CT, USA, VA Connecticut Healthcare System, West Haven, CT, USA, Academisch Medisch Centrum bij de Universiteit van Amsterdam, Amsterdam, The Netherlands, University Hospital Lausanne, Lausanne, Switzerland, Clinic of Infectious Diseases & Tropical Medicine, San Paolo Hospital, University of Milan, Italy, Centre d'Estudis Epidemiològics sobre ITS/VIH/SIDA de Catalunya, Badalona, Spain, Division of Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada, Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada, Research Department of Infection and Population Health, UCL Medical School, London, UK, INSERM U.897, ISPED, Université Bordeaux, Bordeaux, France, Department of Internal Medicine University of Cologne, DE, Vanderbilt University School of Medicine, Nashville, TN, USA, National Epidemiology Center. Carlos III Health Institute, Madrid, Spain, Division of Infectious Diseases, University of Calgary, Calgary, Canada, University of Washington School of Medicine, Seattle, WA, USA, Division of Infectious Disease, Department of Medicine, University of Alabama, Birmingham, USA, HIV Atlanta VA Cohort Study (HAVACS), Atlanta Veterans Affairs Medical Center, Decatur, GA, USA and Johann Wolfgang Goethe-Universität, HIVCENTER, Frankfurt, Germany
| | - M John Gill
- School of Social and Community Medicine, University of Bristol, Bristol, UK, UPMC Univ Paris 06, UMR_S 943, F-75013, Paris, France; INSERM, UMR_S 943, F-75013, Paris, France; AP-HP, Hôpital Pitié-Salpétrière, Service des maladies infectieuses et tropicales, F-75013, Paris, France, Yale University School of Medicine, New Haven, CT, USA, VA Connecticut Healthcare System, West Haven, CT, USA, Academisch Medisch Centrum bij de Universiteit van Amsterdam, Amsterdam, The Netherlands, University Hospital Lausanne, Lausanne, Switzerland, Clinic of Infectious Diseases & Tropical Medicine, San Paolo Hospital, University of Milan, Italy, Centre d'Estudis Epidemiològics sobre ITS/VIH/SIDA de Catalunya, Badalona, Spain, Division of Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada, Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada, Research Department of Infection and Population Health, UCL Medical School, London, UK, INSERM U.897, ISPED, Université Bordeaux, Bordeaux, France, Department of Internal Medicine University of Cologne, DE, Vanderbilt University School of Medicine, Nashville, TN, USA, National Epidemiology Center. Carlos III Health Institute, Madrid, Spain, Division of Infectious Diseases, University of Calgary, Calgary, Canada, University of Washington School of Medicine, Seattle, WA, USA, Division of Infectious Disease, Department of Medicine, University of Alabama, Birmingham, USA, HIV Atlanta VA Cohort Study (HAVACS), Atlanta Veterans Affairs Medical Center, Decatur, GA, USA and Johann Wolfgang Goethe-Universität, HIVCENTER, Frankfurt, Germany
| | - Heidi M Crane
- School of Social and Community Medicine, University of Bristol, Bristol, UK, UPMC Univ Paris 06, UMR_S 943, F-75013, Paris, France; INSERM, UMR_S 943, F-75013, Paris, France; AP-HP, Hôpital Pitié-Salpétrière, Service des maladies infectieuses et tropicales, F-75013, Paris, France, Yale University School of Medicine, New Haven, CT, USA, VA Connecticut Healthcare System, West Haven, CT, USA, Academisch Medisch Centrum bij de Universiteit van Amsterdam, Amsterdam, The Netherlands, University Hospital Lausanne, Lausanne, Switzerland, Clinic of Infectious Diseases & Tropical Medicine, San Paolo Hospital, University of Milan, Italy, Centre d'Estudis Epidemiològics sobre ITS/VIH/SIDA de Catalunya, Badalona, Spain, Division of Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada, Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada, Research Department of Infection and Population Health, UCL Medical School, London, UK, INSERM U.897, ISPED, Université Bordeaux, Bordeaux, France, Department of Internal Medicine University of Cologne, DE, Vanderbilt University School of Medicine, Nashville, TN, USA, National Epidemiology Center. Carlos III Health Institute, Madrid, Spain, Division of Infectious Diseases, University of Calgary, Calgary, Canada, University of Washington School of Medicine, Seattle, WA, USA, Division of Infectious Disease, Department of Medicine, University of Alabama, Birmingham, USA, HIV Atlanta VA Cohort Study (HAVACS), Atlanta Veterans Affairs Medical Center, Decatur, GA, USA and Johann Wolfgang Goethe-Universität, HIVCENTER, Frankfurt, Germany
| | - Michael S Saag
- School of Social and Community Medicine, University of Bristol, Bristol, UK, UPMC Univ Paris 06, UMR_S 943, F-75013, Paris, France; INSERM, UMR_S 943, F-75013, Paris, France; AP-HP, Hôpital Pitié-Salpétrière, Service des maladies infectieuses et tropicales, F-75013, Paris, France, Yale University School of Medicine, New Haven, CT, USA, VA Connecticut Healthcare System, West Haven, CT, USA, Academisch Medisch Centrum bij de Universiteit van Amsterdam, Amsterdam, The Netherlands, University Hospital Lausanne, Lausanne, Switzerland, Clinic of Infectious Diseases & Tropical Medicine, San Paolo Hospital, University of Milan, Italy, Centre d'Estudis Epidemiològics sobre ITS/VIH/SIDA de Catalunya, Badalona, Spain, Division of Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada, Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada, Research Department of Infection and Population Health, UCL Medical School, London, UK, INSERM U.897, ISPED, Université Bordeaux, Bordeaux, France, Department of Internal Medicine University of Cologne, DE, Vanderbilt University School of Medicine, Nashville, TN, USA, National Epidemiology Center. Carlos III Health Institute, Madrid, Spain, Division of Infectious Diseases, University of Calgary, Calgary, Canada, University of Washington School of Medicine, Seattle, WA, USA, Division of Infectious Disease, Department of Medicine, University of Alabama, Birmingham, USA, HIV Atlanta VA Cohort Study (HAVACS), Atlanta Veterans Affairs Medical Center, Decatur, GA, USA and Johann Wolfgang Goethe-Universität, HIVCENTER, Frankfurt, Germany
| | - Jodie Guest
- School of Social and Community Medicine, University of Bristol, Bristol, UK, UPMC Univ Paris 06, UMR_S 943, F-75013, Paris, France; INSERM, UMR_S 943, F-75013, Paris, France; AP-HP, Hôpital Pitié-Salpétrière, Service des maladies infectieuses et tropicales, F-75013, Paris, France, Yale University School of Medicine, New Haven, CT, USA, VA Connecticut Healthcare System, West Haven, CT, USA, Academisch Medisch Centrum bij de Universiteit van Amsterdam, Amsterdam, The Netherlands, University Hospital Lausanne, Lausanne, Switzerland, Clinic of Infectious Diseases & Tropical Medicine, San Paolo Hospital, University of Milan, Italy, Centre d'Estudis Epidemiològics sobre ITS/VIH/SIDA de Catalunya, Badalona, Spain, Division of Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada, Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada, Research Department of Infection and Population Health, UCL Medical School, London, UK, INSERM U.897, ISPED, Université Bordeaux, Bordeaux, France, Department of Internal Medicine University of Cologne, DE, Vanderbilt University School of Medicine, Nashville, TN, USA, National Epidemiology Center. Carlos III Health Institute, Madrid, Spain, Division of Infectious Diseases, University of Calgary, Calgary, Canada, University of Washington School of Medicine, Seattle, WA, USA, Division of Infectious Disease, Department of Medicine, University of Alabama, Birmingham, USA, HIV Atlanta VA Cohort Study (HAVACS), Atlanta Veterans Affairs Medical Center, Decatur, GA, USA and Johann Wolfgang Goethe-Universität, HIVCENTER, Frankfurt, Germany
| | - Hans-Reinhard Brodt
- School of Social and Community Medicine, University of Bristol, Bristol, UK, UPMC Univ Paris 06, UMR_S 943, F-75013, Paris, France; INSERM, UMR_S 943, F-75013, Paris, France; AP-HP, Hôpital Pitié-Salpétrière, Service des maladies infectieuses et tropicales, F-75013, Paris, France, Yale University School of Medicine, New Haven, CT, USA, VA Connecticut Healthcare System, West Haven, CT, USA, Academisch Medisch Centrum bij de Universiteit van Amsterdam, Amsterdam, The Netherlands, University Hospital Lausanne, Lausanne, Switzerland, Clinic of Infectious Diseases & Tropical Medicine, San Paolo Hospital, University of Milan, Italy, Centre d'Estudis Epidemiològics sobre ITS/VIH/SIDA de Catalunya, Badalona, Spain, Division of Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada, Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada, Research Department of Infection and Population Health, UCL Medical School, London, UK, INSERM U.897, ISPED, Université Bordeaux, Bordeaux, France, Department of Internal Medicine University of Cologne, DE, Vanderbilt University School of Medicine, Nashville, TN, USA, National Epidemiology Center. Carlos III Health Institute, Madrid, Spain, Division of Infectious Diseases, University of Calgary, Calgary, Canada, University of Washington School of Medicine, Seattle, WA, USA, Division of Infectious Disease, Department of Medicine, University of Alabama, Birmingham, USA, HIV Atlanta VA Cohort Study (HAVACS), Atlanta Veterans Affairs Medical Center, Decatur, GA, USA and Johann Wolfgang Goethe-Universität, HIVCENTER, Frankfurt, Germany
| | - Jonathan A C Sterne
- School of Social and Community Medicine, University of Bristol, Bristol, UK, UPMC Univ Paris 06, UMR_S 943, F-75013, Paris, France; INSERM, UMR_S 943, F-75013, Paris, France; AP-HP, Hôpital Pitié-Salpétrière, Service des maladies infectieuses et tropicales, F-75013, Paris, France, Yale University School of Medicine, New Haven, CT, USA, VA Connecticut Healthcare System, West Haven, CT, USA, Academisch Medisch Centrum bij de Universiteit van Amsterdam, Amsterdam, The Netherlands, University Hospital Lausanne, Lausanne, Switzerland, Clinic of Infectious Diseases & Tropical Medicine, San Paolo Hospital, University of Milan, Italy, Centre d'Estudis Epidemiològics sobre ITS/VIH/SIDA de Catalunya, Badalona, Spain, Division of Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada, Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada, Research Department of Infection and Population Health, UCL Medical School, London, UK, INSERM U.897, ISPED, Université Bordeaux, Bordeaux, France, Department of Internal Medicine University of Cologne, DE, Vanderbilt University School of Medicine, Nashville, TN, USA, National Epidemiology Center. Carlos III Health Institute, Madrid, Spain, Division of Infectious Diseases, University of Calgary, Calgary, Canada, University of Washington School of Medicine, Seattle, WA, USA, Division of Infectious Disease, Department of Medicine, University of Alabama, Birmingham, USA, HIV Atlanta VA Cohort Study (HAVACS), Atlanta Veterans Affairs Medical Center, Decatur, GA, USA and Johann Wolfgang Goethe-Universität, HIVCENTER, Frankfurt, Germany
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28
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Abstract
We review studies estimating life expectancy (LE), the average number of additional years a person can expect to live, for HIV-positive adults and show variation by sociodemographic factors and level of immunosuppression. The LE of patients starting antiretroviral therapy early in the course of HIV infection and attaining restoration of a normal CD4 count may approach that of the general population. Improvements in treatment and the associated increase in LE imply that increasing numbers of HIV-positive patients will live to older age. Late diagnosis and presentation to care and treatment not concordant with guidelines contribute to reducing LE.
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