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3 results on '"MESH: Antiretroviral Therapy, Highly Active"'

1. Non-AIDS-defining deaths and immunodeficiency in the era of combination antiretroviral therapy

Author

A. Sarah Walker, Osamah Hamouda, Virginie Rondeau, Maria Dorrucci, Heiner C. Bucher, Maria Prins, Geneviève Chêne, Kholoud Porter, Caroline A. Sabin, Rodolphe Thiébaut, Benoît Marin, Dominique Costagliola, Epidémiologie et Biostatistique [Bordeaux], Université Bordeaux Segalen - Bordeaux 2-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de l'Information Médicale et de l'Évaluation [CHU Limoges] (SIME), CHU Limoges, Neuroépidémiologie Tropicale et Comparée (NETEC), Université de Limoges (UNILIM)-Institut d'Epidémiologie Neurologique et de Neurologie Tropicale-Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST FR CNRS 3503), Basel Institute for Clinical Epidemiology, University Hospital Basel [Basel], Epidémiologie Clinique et Traitement de l'Infection à VIH, Université Pierre et Marie Curie - Paris 6 (UPMC)-IFR113-Institut National de la Santé et de la Recherche Médicale (INSERM), Dipartimento di Malattie Infettive, Reparto di Epidemiologia, Istituto Superiore di Sanita [Rome], Department of Infectious Disease Epidemiology, Robert Koch Institute [Berlin] (RKI), Cluster Infectious Diseases, Amsterdam BioMed Cluster, Medical Research Council Clinical Trials Unit (MRC CTU), University College of London [London] (UCL), Research Department of Infection and Population Health [London], CASCADE has been funded through grants from the European Union BMH4-CT97-2550, QLK2-2000-01431, QLRT-2001-01708 and LSHP-CT-2006-018949., Istituto Superiore di Sanità (ISS), AII - Amsterdam institute for Infection and Immunity, APH - Amsterdam Public Health, and Infectious diseases

Subjects
Male, MESH: CD4 Lymphocyte Count, medicine.medical_treatment, CD4 cell count, Disease, MESH: Epidemiologic Methods, MESH: Antiretroviral Therapy, Highly Active, Hepatitis, Liver disease, 0302 clinical medicine, Antiretroviral Therapy, Highly Active, Neoplasms, Immunology and Allergy, MESH: Neoplasms, 030212 general & internal medicine, Causes of death, Immunodeficiency, MESH: Aged, 0303 health sciences, MESH: Middle Aged, MESH: AIDS-Related Opportunistic Infections, Liver Diseases, Immunosuppression, Middle Aged, Human Immunodeficiency Virus/AIDS, Antiretroviral therapy, 3. Good health, Infectious Diseases, Cardiovascular Diseases, MESH: Young Adult, Female, Viral disease, Adult, medicine.medical_specialty, MESH: Immune Tolerance, MESH: Liver Diseases, Adolescent, Immunology, Article, Young Adult, 03 medical and health sciences, Acquired immunodeficiency syndrome (AIDS), Internal medicine, Immune Tolerance, medicine, Humans, Seroconversion, highly active, Aged, MESH: Acquired Immunodeficiency Syndrome, MESH: Adolescent, Acquired Immunodeficiency Syndrome, MESH: Humans, AIDS-Related Opportunistic Infections, 030306 microbiology, business.industry, MESH: Cardiovascular Diseases, MESH: Adult, medicine.disease, MESH: Male, CD4 Lymphocyte Count, Neoplasm, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Bacterial infection, Epidemiologic Methods, business, MESH: Female
Abstract

International audience; OBJECTIVE: To assess whether immunodeficiency is associated with the most frequent non-AIDS-defining causes of death in the era of combination antiretroviral therapy (cART). DESIGN: Observational multicentre cohorts. METHODS: Twenty-three cohorts of adults with estimated dates of human immunodeficiency virus (HIV) seroconversion were considered. Patients were seroconverters followed within the cART era. Measurements were latest CD4, nadir CD4 and time spent with CD4 cell count less than 350 cells/microl. Outcomes were specific causes of death using a standardized classification. RESULTS: Among 9858 patients (71 230 person-years follow-up), 597 died, 333 (55.7%) from non-AIDS-defining causes. Non-AIDS-defining infection, liver disease, non-AIDS-defining malignancy and cardiovascular disease accounted for 53% of non-AIDS deaths. For each 100 cells/microl increment in the latest CD4 cell count, we found a 64% (95% confidence interval 58-69%) reduction in risk of death from AIDS-defining causes and significant reductions in death from non-AIDS infections (32, 18-44%), end-stage liver disease (33, 18-46%) and non-AIDS malignancies (34, 21-45%). Non-AIDS-defining causes of death were also associated with nadir CD4 while being cART-naive or duration of exposure to immunosuppression. No relationship between risk of death from cardiovascular disease and CD4 cell count was found though there was a raised risk associated with elevated HIV RNA. CONCLUSION: In the cART era, the most frequent non-AIDS-defining causes of death are associated with immunodeficiency, only cardiovascular disease was associated with high viral replication. Avoiding profound and mild immunodeficiency, through earlier initiation of cART, may impact on morbidity and mortality of HIV-infected patients.

Published
2009
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2. Impact of genotypic drug resistance mutations on clinical and immunological outcomes in HIV-infected adults on HAART in West Africa

Author

Delphine Gabillard, Siaka Toure, Catherine Seyler, Monica Nolan, Eugène Messou, Xavier Anglaret, Nicole Dakoury-Dogbo, François Rouet, Christiane Adjé-Touré, Epidémiologie, santé publique et développement, Université Bordeaux Segalen - Bordeaux 2-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR99-ISPED, Cotrame Study Group (ANRS 1203), ANRS France Recherche Nord & sud Sida-hiv hépatites, Projet RETRO-CI, Association ACONDA-VS, Centre de recherche et de Diagnostic sur le Sida [Abidjan, Côte d'Ivoire] (CeDreS), Centre Hospitalier Universitaire de Treichville [Abidjan, Côte d'Ivoire] (CHU de Treichville), and Anglaret, Xavier

Subjects
Male, MESH: CD4 Lymphocyte Count, medicine.medical_treatment, HIV Infections, Drug resistance, MESH: Antiretroviral Therapy, Highly Active, MESH: Genotype, MESH: HIV-1, Cohort Studies, MESH: HIV-2, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Immunopathology, Antiretroviral Therapy, Highly Active, Genotype, Immunology and Allergy, Sida, MESH: Cohort Studies, MESH: Treatment Outcome, education.field_of_study, MESH: Drug Resistance, Viral, biology, MESH: HIV Infections, Viral Load, Infectious Diseases, Treatment Outcome, [SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Female, Viral disease, MESH: Viral Load, Viral load, Adult, MESH: Mutation, MESH: Cote d'Ivoire, Immunology, Population, Drug Resistance, Viral, medicine, Humans, education, Chemotherapy, MESH: Humans, business.industry, MESH: Adult, biology.organism_classification, Virology, MESH: Male, CD4 Lymphocyte Count, Cote d'Ivoire, HIV-2, Mutation, HIV-1, business, MESH: Female
Abstract

OBJECTIVES: To analyse the association between the presence of resistance mutations and treatment outcomes. The impact of HIV-1 drug resistance mutations in African adults on HAART has so far never been reported. METHODS: In 2004 in Abidjan, C?d'Ivoire, 106 adults on HAART had plasma viral load measurements. Patients with detectable viral loads had resistance genotypic tests. Patients were followed until 2006. Main outcomes were serious morbidity and immunological failure (CD4 cell count < 200 cells/microl). RESULTS: At study entry, the median previous time on HAART was 37 months and the median CD4 cell count was 266 cells/microl; 58% of patients had undetectable viral loads, 20% had detectable viral loads with no major resistance mutations, and 22% had detectable viral loads with one or more major mutations. The median change in CD4 cell count between study entry and study termination was +129 cells/microl in patients with undetectable viral loads, +51 cells/microl in those with detectable viral loads with no mutations and +3 cells/microl in those with detectable viral loads with resistance mutations. Compared with patients with undetectable viral loads, those with detectable viral loads with resistance mutations had adjusted hazard ratios of immunological failure of 4.32 (95%CI 1.38-13.57, P = 0.01). One patient died. The 18-month probability of remaining free of morbidity was 0.79 in patients with undetectable viral loads and 0.69 in those with resistance mutations (P = 0.19). CONCLUSION: In this setting with restricted access to second-line HAART, patients with major resistance mutations had higher rates of immunological failure, but most maintained stable CD4 cell counts and stayed alive for at least 20 months.

Published
2007
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3. CCR5 delta32 deletion and response to highly active antiretroviral therapy in HIV-1-infected patients

Author

Guérin, Sylvie, Meyer, Laurence, Theodorou, Ioannis, Boufassa, Faroudy, Magierowska, Magda, Goujard, Cécile, Rouzioux, Christine, Debré, Patrice, Delfraissy, Jean-François, Study Group, The Seroco/hemoco, Epidémiologie, Démographie et Sciences Sociales: santé reproductive, sexualité et infection à VIH (Inserm U569), Epidémiologie, sciences sociales, santé publique (IFR 69), Université Paris 1 Panthéon-Sorbonne (UP1)-Université Paris-Sud - Paris 11 (UP11)-École des hautes études en sciences sociales (EHESS)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Paris 1 Panthéon-Sorbonne (UP1)-Université Paris-Sud - Paris 11 (UP11)-École des hautes études en sciences sociales (EHESS)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Institut national d'études démographiques (INED)-Institut National de la Santé et de la Recherche Médicale (INSERM), Santé publique, épidémiologie. Reproduction humaine, Institut National de la Santé et de la Recherche Médicale (INSERM), Immunologie cellulaire et tissulaire, Université Pierre et Marie Curie - Paris 6 (UPMC)-IFR113-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de médecine interne et maladies infectieuses, Hôpital Bicêtre-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris-Sud - Paris 11 (UP11), Service d'Immunologie [CHU Pitié-Salpétrière], CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Bicêtre, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)

Subjects
Genotype, Receptors, CCR5, Anti-HIV Agents, medicine.medical_treatment, Immunology, Human immunodeficiency virus (HIV), MESH: Logistic Models, HIV Infections, Biology, MESH: Receptors, CCR5, medicine.disease_cause, MESH: Antiretroviral Therapy, Highly Active, MESH: Genotype, Cohort Studies, Pharmacotherapy, Acquired immunodeficiency syndrome (AIDS), Immunopathology, Antiretroviral Therapy, Highly Active, medicine, Odds Ratio, Immunology and Allergy, Humans, MESH: Anti-HIV Agents, Sida, MESH: Cohort Studies, MESH: Treatment Outcome, Sequence Deletion, Chemotherapy, MESH: Humans, MESH: Follow-Up Studies, MESH: HIV Infections, MESH: Sequence Deletion, medicine.disease, biology.organism_classification, Antiretroviral therapy, Virology, MESH: Odds Ratio, Infectious Diseases, Logistic Models, Treatment Outcome, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Viral disease, Follow-Up Studies
Published
2000

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