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1. Development and validation of a risk score for chronic kidney disease in HIV infection using prospective cohort data from the D:A:D study.

Author

Amanda Mocroft, Jens D Lundgren, Michael Ross, Matthew Law, Peter Reiss, Ole Kirk, Colette Smith, Deborah Wentworth, Jacqueline Neuhaus, Christoph A Fux, Olivier Moranne, Phillipe Morlat, Margaret A Johnson, Lene Ryom, D:A:D study group, Royal Free Hospital Clinic Cohort, INSIGHT study group, SMART study group, and ESPRIT study group

Subjects
Medicine
Abstract

BackgroundChronic kidney disease (CKD) is a major health issue for HIV-positive individuals, associated with increased morbidity and mortality. Development and implementation of a risk score model for CKD would allow comparison of the risks and benefits of adding potentially nephrotoxic antiretrovirals to a treatment regimen and would identify those at greatest risk of CKD. The aims of this study were to develop a simple, externally validated, and widely applicable long-term risk score model for CKD in HIV-positive individuals that can guide decision making in clinical practice.Methods and findingsA total of 17,954 HIV-positive individuals from the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study with ≥3 estimated glomerular filtration rate (eGFR) values after 1 January 2004 were included. Baseline was defined as the first eGFR > 60 ml/min/1.73 m2 after 1 January 2004; individuals with exposure to tenofovir, atazanavir, atazanavir/ritonavir, lopinavir/ritonavir, other boosted protease inhibitors before baseline were excluded. CKD was defined as confirmed (>3 mo apart) eGFR ≤ 60 ml/min/1.73 m2. Poisson regression was used to develop a risk score, externally validated on two independent cohorts. In the D:A:D study, 641 individuals developed CKD during 103,185 person-years of follow-up (PYFU; incidence 6.2/1,000 PYFU, 95% CI 5.7-6.7; median follow-up 6.1 y, range 0.3-9.1 y). Older age, intravenous drug use, hepatitis C coinfection, lower baseline eGFR, female gender, lower CD4 count nadir, hypertension, diabetes, and cardiovascular disease (CVD) predicted CKD. The adjusted incidence rate ratios of these nine categorical variables were scaled and summed to create the risk score. The median risk score at baseline was -2 (interquartile range -4 to 2). There was a 1:393 chance of developing CKD in the next 5 y in the low risk group (risk score < 0, 33 events), rising to 1:47 and 1:6 in the medium (risk score 0-4, 103 events) and high risk groups (risk score ≥ 5, 505 events), respectively. Number needed to harm (NNTH) at 5 y when starting unboosted atazanavir or lopinavir/ritonavir among those with a low risk score was 1,702 (95% CI 1,166-3,367); NNTH was 202 (95% CI 159-278) and 21 (95% CI 19-23), respectively, for those with a medium and high risk score. NNTH was 739 (95% CI 506-1462), 88 (95% CI 69-121), and 9 (95% CI 8-10) for those with a low, medium, and high risk score, respectively, starting tenofovir, atazanavir/ritonavir, or another boosted protease inhibitor. The Royal Free Hospital Clinic Cohort included 2,548 individuals, of whom 94 individuals developed CKD (3.7%) during 18,376 PYFU (median follow-up 7.4 y, range 0.3-12.7 y). Of 2,013 individuals included from the SMART/ESPRIT control arms, 32 individuals developed CKD (1.6%) during 8,452 PYFU (median follow-up 4.1 y, range 0.6-8.1 y). External validation showed that the risk score predicted well in these cohorts. Limitations of this study included limited data on race and no information on proteinuria.ConclusionsBoth traditional and HIV-related risk factors were predictive of CKD. These factors were used to develop a risk score for CKD in HIV infection, externally validated, that has direct clinical relevance for patients and clinicians to weigh the benefits of certain antiretrovirals against the risk of CKD and to identify those at greatest risk of CKD.

Published
2015
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2. Development and validation of a risk score for chronic kidney disease in HIV infection using prospective cohort data from the D:A:D study.

Author

Mocroft, Amanda, Lundgren, Jens D, Ross, Michael, Law, Matthew, Reiss, Peter, Kirk, Ole, Smith, Colette, Wentworth, Deborah, Neuhaus, Jacqueline, Fux, Christoph A, Moranne, Olivier, Morlat, Phillipe, Johnson, Margaret A, Ryom, Lene, D:A:D study group, Royal Free Hospital Clinic Cohort, INSIGHT study group, SMART study group, and ESPRIT study group

Subjects
D:A:D study group, Royal Free Hospital Clinic Cohort, INSIGHT study group, SMART study group, ESPRIT study group, Kidney, Humans, HIV, HIV Infections, HIV Seropositivity, Anti-HIV Agents, CD4 Lymphocyte Count, Incidence, Risk, Risk Assessment, Prospective Studies, Age Factors, Comorbidity, Sex Factors, Adult, Middle Aged, Female, Male, Renal Insufficiency, Chronic, Clinical Decision-Making, Renal Insufficiency, Chronic, General & Internal Medicine, Medical and Health Sciences
Abstract

BackgroundChronic kidney disease (CKD) is a major health issue for HIV-positive individuals, associated with increased morbidity and mortality. Development and implementation of a risk score model for CKD would allow comparison of the risks and benefits of adding potentially nephrotoxic antiretrovirals to a treatment regimen and would identify those at greatest risk of CKD. The aims of this study were to develop a simple, externally validated, and widely applicable long-term risk score model for CKD in HIV-positive individuals that can guide decision making in clinical practice.Methods and findingsA total of 17,954 HIV-positive individuals from the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study with ≥3 estimated glomerular filtration rate (eGFR) values after 1 January 2004 were included. Baseline was defined as the first eGFR > 60 ml/min/1.73 m2 after 1 January 2004; individuals with exposure to tenofovir, atazanavir, atazanavir/ritonavir, lopinavir/ritonavir, other boosted protease inhibitors before baseline were excluded. CKD was defined as confirmed (>3 mo apart) eGFR ≤ 60 ml/min/1.73 m2. Poisson regression was used to develop a risk score, externally validated on two independent cohorts. In the D:A:D study, 641 individuals developed CKD during 103,185 person-years of follow-up (PYFU; incidence 6.2/1,000 PYFU, 95% CI 5.7-6.7; median follow-up 6.1 y, range 0.3-9.1 y). Older age, intravenous drug use, hepatitis C coinfection, lower baseline eGFR, female gender, lower CD4 count nadir, hypertension, diabetes, and cardiovascular disease (CVD) predicted CKD. The adjusted incidence rate ratios of these nine categorical variables were scaled and summed to create the risk score. The median risk score at baseline was -2 (interquartile range -4 to 2). There was a 1:393 chance of developing CKD in the next 5 y in the low risk group (risk score < 0, 33 events), rising to 1:47 and 1:6 in the medium (risk score 0-4, 103 events) and high risk groups (risk score ≥ 5, 505 events), respectively. Number needed to harm (NNTH) at 5 y when starting unboosted atazanavir or lopinavir/ritonavir among those with a low risk score was 1,702 (95% CI 1,166-3,367); NNTH was 202 (95% CI 159-278) and 21 (95% CI 19-23), respectively, for those with a medium and high risk score. NNTH was 739 (95% CI 506-1462), 88 (95% CI 69-121), and 9 (95% CI 8-10) for those with a low, medium, and high risk score, respectively, starting tenofovir, atazanavir/ritonavir, or another boosted protease inhibitor. The Royal Free Hospital Clinic Cohort included 2,548 individuals, of whom 94 individuals developed CKD (3.7%) during 18,376 PYFU (median follow-up 7.4 y, range 0.3-12.7 y). Of 2,013 individuals included from the SMART/ESPRIT control arms, 32 individuals developed CKD (1.6%) during 8,452 PYFU (median follow-up 4.1 y, range 0.6-8.1 y). External validation showed that the risk score predicted well in these cohorts. Limitations of this study included limited data on race and no information on proteinuria.ConclusionsBoth traditional and HIV-related risk factors were predictive of CKD. These factors were used to develop a risk score for CKD in HIV infection, externally validated, that has direct clinical relevance for patients and clinicians to weigh the benefits of certain antiretrovirals against the risk of CKD and to identify those at greatest risk of CKD.

Published
2015

4. Clin Infect Dis

Author

Shepherd, L., Ryom, L., Law, M., Petoumenos, K., Hatleberg, C. I., D'Arminio Monforte, A., Sabin, C., Bower, M., Bonnet, F., Reiss, P., De Wit, S., Pradier, C., Weber, R., El-Sadr, W., Lundgren, J., Mocroft, A., the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) Study Group, Segala, Daniela, Global Health, Infectious diseases, AII - Infectious diseases, APH - Aging & Later Life, Bordeaux population health (BPH), and Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM)

Subjects
0301 basic medicine, Microbiology (medical), Adult, Male, medicine.medical_specialty, medicine.medical_treatment, 030106 microbiology, Human immunodeficiency virus (HIV), HIV, smoking, smoking cessation, cancer, HIV Infections, medicine.disease_cause, smoking, NO, FR, 03 medical and health sciences, symbols.namesake, 0302 clinical medicine, Internal medicine, Neoplasms, medicine, cancer, MORPH3Eus, Humans, DAD, 030212 general & internal medicine, Poisson regression, Prospective Studies, Lung cancer, Adverse effect, Aged, Aged, 80 and over, Lung, business.industry, Incidence (epidemiology), Incidence, HIV, Cancer, Middle Aged, medicine.disease, 3. Good health, Infectious Diseases, medicine.anatomical_structure, symbols, Smoking cessation, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Female, Smoking Cessation, business
Abstract

Background Cancers are a major source of morbidity and mortality for HIV-positive persons on combination antiretroviral therapy, while the clinical benefits of smoking cessation are not well established. Methods Participants were followed from 1 January 2004 until first cancer diagnosis, death, or 1 February 2016. Smoking status was defined as ex ( 5 years since stopping), current, and never smokers. Outcomes considered were any cancer, lung cancer, other smoking-related excluding lung and smoking-unrelated cancers. Adjusted incidence rate ratios (aIRR) were calculated using Poisson regression, adjusting for demographic and clinical factors. Results 35442 persons from the D:A:D study contributed 309803 person years of follow-up. At baseline, 49% of people were current smokers, 21% were ex-smokers, 30% had never smoked. Incidence of all cancers combined (N=2183) was highest

Published
2018

5. Gender differences in the use of cardiovascular interventions in HIV-positive persons; the D:A:D study

Author

Hatleberg, Ci, Ryom, L, El-Sadr, W, Mocroft, A, Reiss, P, De Wit, S, Dabis, F, Pradier, C, d'Arminio Monforte, A, Kovari, H, Law, M, Lundgren, Jd, Sabin, Ca, Data Collection of Adverse Events of Anti-HIV drugs (D:A:D) Study group, Calvo, G, Bonnet, F, Kirk, O, Morfeldt, L, Weber, R, Lind-Thomsen, A, Salbøl Brandt, R, Hillebreght, M, Zaheri, S, Wit, F, Scherrer, A, Schöni-Affolter, F, Rickenbach, M, Tavelli, A, Fanti, I, Leleux, O, Mourali, J, Le Marec, F, Boerg, E, Thulin, E, Sundström, A, Bartsch, G, Thompsen, G, Necsoi, C, Delforge, M, Fontas, E, Caissotti, C, Mateu, S, Torres, F, Petoumenos, K, Blance, A, Huang, R, Puhr, R, Laut, K, Kristensen, D, Phillips, An, Kamara, Da, Smith, Cj, Brandt, Rs, Raben, D, Matthews, C, Bojesen, A, Grevsen, Al, Powderly, B, Shortman, N, Moecklinghoff, C, Reilly, G, Franquet, X, Smit, C, Ross, M, Fux, Ca, Morlat, P, Friis-Møller, N, Kowalska, J, Bohlius, J, Bower, M, Fätkenheuer, G, Grulich, A, Sjøl, A, Meidahl, P, Iversen, Js, Hillebregt, M, Prins, Jm, Kuijpers, Tw, Scherpbier, Hj, van der Meer, J, Godfried, Mh, van der Poll, T, Nellen, F, Geerlings, Se, van Vugt, M, Pajkrt, D, Bos, Jc, Wiersinga, Wj, van der Valk, M, Goorhuis, A, Hovius, Jw, van Eden, J, Henderiks, A, van Hes, A, Mutschelknauss, M, Nobel, He, Pijnappel, F, Jurriaans, S, Back, N, Zaaijer, Hl, Berkhout, B, Cornelissen, M, Schinkel, Cj, Thomas, Xv, De Ruyter Ziekenhuis, A, van den Berge, M, Stegeman, A, Baas, S, Hage de Looff, L, Ziekenhuis, C, Pronk, M, Ammerlaan, H, de Munnik, E, Tjhie, J, Wegdam, M, Deiman, B, Scharnhorst, V, Weijsenfeld, Am, van der Ende ME, van Gorp, E, Schurink, C, Nouwen, Jl, Verbon, A, Rijnders, B, Bax, Hi, van der Feltz, M, van der Bassant, N, van Beek, J, Vriesde, M, van Zonneveld LM, de Oude-Lubbers, A, van den Berg-Cameron HJ, Bruinsma-Broekman, Fb, de Groot, J, de Zeeuw-de Man, M, Boucher, C, Koopmans, M, van Kampen, J, Pas, Sd, Driessen, G, van Rossum, A, van der Knaap LC, Flevoziekenhuis, E, Branger, J, Rijkeboer-Mes, A, Schippers, Ef, van IJperen JM, Geilings, J, van der Hut, G, Franck, P, van Eeden, A, Brokking, W, Groot, M, Elsenburg, L, Damen, M, Isala, Is, Groeneveld, P, Bouwhuis, Jw, den Berg JF, van Hulzen, A, van der Bliek GL, Bor, P, Bloembergen, P, Wolfhagen, M, Ruijs, G, Kroon, Fp, de Boer, M, Bauer, Mp, Jolink, H, Vollaard, Am, Dorama, W, van Holten, N, Claas, E, Wessels, E, den Hollander JG, Pogany, K, Roukens, A, Kastelijns, M, Smit, Jv, Smit, E, Struik-Kalkman, D, Tearno, C, Bezemer, M, van Niekerk, T, Pontesilli, O, Lowe, Sh, Oude Lashof, A, Posthouwer, D, Ackens, Rp, Schippers, J, Vergoossen, R, Weijenberg-Maes, B, van Loo, I, Havenith, T, Leyten, E, Gelinck, L, van Hartingsveld, A, Meerkerk, C, Wildenbeest, Gs, Mutsaers, J, Jansen, Cl, Mulder, Jw, Vrouenraets, S, Lauw, Fn, van Broekhuizen MC, Paap, H, Vlasblom, Dj, Smits, P, Weijer, S, El Moussaoui, R, Bosma, As, van Vonderen, M, van Houte, D, Kampschreur, Lm, Dijkstra, K, Faber, S, Weel, J, Kootstra, Gj, Delsing, Ce, van der Burg-van de Plas, M, Heins, H, Lucas, E, Kortmann, W, van Twillert, G, Cohen Stuart, J, Diederen, B, Pronk, D, van Truijen-Oud FA, van der Reijden WA, Jansen, R, Brinkman, K, den Berk, G, Blok, Wl, Frissen, P, Lettinga, Kd, Schouten, W, Veenstra, J, Brouwer, Cj, Geerders, Gf, Hoeksema, K, Kleene, Mj, van der Meché IB, Spelbrink, M, Sulman, H, Toonen, A, Wijnands, S, Kwa, D, Witte, E, Koopmans, Pp, Keuter, M, van der Ven, A, Ter Hofstede, H, Dofferhoff, A, van Crevel, R, Albers, M, Bosch, M, Grintjes-Huisman, K, Zomer, Bj, Stelma, Ff, Rahamat-Langendoen, J, Burger, D, Richter, C, Gisolf, Eh, Hassing, Rj, Ter Beest, G, van Bentum, P, Langebeek, N, Tiemessen, R, Swanink, C, van Lelyveld, S, Soetekouw, R, Hulshoff, N, van der Prijt, L, van der Swaluw, J, Bermon, N, Herpers, Bl, Veenendaal, D, Verhagen, D, van Wijk, M, Brouwer, Ae, Kuipers, M, Santegoets, R, van der Ven, B, Marcelis, Jh, Buiting, A, Kabel, Pj, Bierman, W, Scholvinck, H, Wilting, Kr, Stienstra, Y, van der Meulen PA, de Weerd DA, Ludwig-Roukema, J, Niesters, H, Riezebos-Brilman, A, van Leer-Buter CC, Knoester, M, Hoepelman, A, Mudrikova, T, Ellerbroek, Pm, Oosterheert, Jj, Arends, Je, Barth, Re, Wassenberg, M, Schadd, Em, van Elst-Laurijssen, D, van Oers-Hazelzet, E, Vervoort, S, van Berkel, M, Schuurman, R, Verduyn-Lunel, F, Wensing, A, Peters, E, van Agtmael MA, Bomers, M, de Vocht, J, Heitmuller, M, Laan, Lm, Pettersson, Am, Ang, Cw, Geelen, S, Wolfs, T, Bont, Lj, Bezemer, Do, van Sighem AI, Boender, Ts, de Jong, A, Bergsma, D, Hoekstra, P, de Lang, A, Grivell, S, Jansen, A, Rademaker, Mj, Raethke, M, Meijering, R, Schnörr, S, de Groot, L, van den Akker, M, Bakker, Y, Claessen, E, El Berkaoui, A, Koops, J, Kruijne, E, Lodewijk, C, Munjishvili, L, Peeck, B, Ree, C, Regtop, R, Ruijs, Y, Rutkens, T, van de Sande, L, Schoorl, M, Timmerman, A, Tuijn, E, Veenenberg, L, van der Vliet, S, Wisse, A, Woudstra, T, Tuk, B, Dupon, M, Gaborieau, V, Lacoste, D, Malvy, D, Mercié, P, Neau, D, Pellegrin, Jl, Tchamgoué, S, Lazaro, E, Cazanave, C, Vandenhende, M, Vareil, Mo, Gérard, Y, Blanco, P, Bouchet, S, Breilh, D, Fleury, H, Pellegrin, I, Chêne, G, Thiébaut, R, Wittkop, L, Lawson-Ayayi, S, Gimbert, A, Desjardin, S, Lacaze-Buzy, L, Petrov-Sanchez, V, André, K, Bernard, N, Caubet, O, Caunegre, L, Chossat, I, Courtault, C, Dauchy, Fa, Dondia, D, Duffau, P, Dutronc, H, Farbos, S, Faure, I, Ferrand, H, Gerard, Y, Greib, C, Hessamfar, M, Imbert, Y, Lataste, P, Marie, J, Mechain, M, Monlun, E, Ochoa, A, Pistone, T, Raymond, I, Receveur, Mc, Rispal, P, Sorin, L, Valette, C, Vandenhende, Ma, Viallard, Jf, Wille, H, Wirth, G, Lafon, Me, Trimoulet, P, Bellecave, P, Tumiotto, C, Haramburu, F, Miremeont-Salamé, G, Blaizeau, Mj, Decoin, M, Hannapier, C, Pougetoux, Elea, Delveaux, S, D'Ivernois, C, Diarra, F, Uwamaliya-Nziyumvira, B, Palmer, G, Conte, V, Sapparrart, V, Moore, R, Edwards, S, Hoy, J, Watson, K, Roth, N, Lau, H, Bloch, M, Baker, D, Carr, A, Cooper, D, O'Sullivan, M, Nolan, D, Guelfi, G, Domingo, P, Sambeat, Ma, Gatell, J, Del Cacho, E, Cadafalch, J, Fuster, M, Codina, C, Sirera, G, Vaqué, A, Clumeck, N, Gennotte, Af, Gerard, M, Kabeya, K, Konopnicki, D, Libois, A, Martin, C, Payen, Mc, Semaille, P, Van Laethem, Y, Neaton, J, Krum, E, Thompson, G, Luskin-Hawk, R, Telzak, E, Abrams, Di, Cohn, D, Markowitz, N, Arduino, R, Mushatt, D, Friedland, G, Perez, G, Tedaldi, E, Fisher, E, Gordin, F, Crane, Lr, Sampson, J, Baxter, J, Gazzard, B, Horban, A, Karpov, I, Losso, M, Pedersen, C, Ristola, M, Phillips, A, Rockstroh, J, Peters, L, Fischer, Ah, Grønborg Laut, K, Larsen, Jf, Podlekareva, D, Cozzi-Lepri, A, Shepherd, L, Schultze, A, Amele, S, Kundro, M, Schmied, B, Vassilenko, A, Mitsura, Vm, Paduto, D, Florence, E, Vandekerckhove, L, Hadziosmanovic, V, Begovac, J, Machala, L, Jilich, D, Kronborg, G, Benfield, T, Gerstoft, J, Katzenstein, T, Møller, Nf, Ostergaard, L, Wiese, L, Nielsen, Ln, Zilmer, K, Aho, I, Viard, Jp, Girard, Pm, Duvivier, C, Degen, O, Stellbrink, Hj, Stefan, C, Bogner, J, Chkhartishvili, N, Gargalianos, P, Szlávik, J, Gottfredsson, M, Mulcahy, F, Yust, I, Turner, D, Burke, M, Shahar, E, Hassoun, G, Elinav, H, Haouzi, M, Elbirt, D, Sthoeger, Zm, Esposito, R, Mazeu, I, Mussini, C, Mazzotta, F, Gabbuti, A, Vullo, V, Lichtner, M, Zaccarelli, M, Antinori, A, Acinapura, R, Plazzi, M, Lazzarin, A, Castagna, A, Gianotti, N, Galli, M, Ridolfo, A, Rozentale, B, Uzdaviniene, V, Staub, T, Ormaasen, V, Maeland, A, Bruun, J, Knysz, B, Gasiorowski, J, Inglot, M, Bakowska, E, Flisiak, R, Grzeszczuk, A, Parczewski, M, Maciejewska, K, Aksak-Was, B, Beniowski, M, Mularska, E, Smiatacz, T, Gensing, M, Jablonowska, E, Malolepsza, E, Wojcik, K, Mozer-Lisewska, I, Caldeira, L, Radoi, R, Panteleev, A, Yakovlev, A, Trofimora, T, Khromova, I, Kuzovatova, E, Borodulina, E, Vdoushkina, E, Jevtovic, D, Tomazic, J, Gatell, Jm, Miró, Jm, Moreno, S, Rodriguez, Jm, Clotet, B, Jou, A, Paredes, R, Tural, C, Puig, J, Bravo, I, Gutierrez, M, Mateo, G, Laporte, Jm, Falconer, K, Thalme, A, Sonnerborg, A, Blaxhult, A, Flamholc, L, Cavassini, M, Calmy, A, Furrer, H, Schmid, P, Kuznetsova, A, Kyselyova, G, Sluzhynska, M, Johnson, Am, Simons, E, Johnson, Ma, Orkin, C, Weber, J, Scullard, G, Clarke, A, Leen, C, Thulin, G, Åkerlund, B, Koppel, K, Karlsson, A, Håkangård, C, Castelli, F, Cauda, R, Di Perri, G, Iardino, R, Ippolito, G, Marchetti, Gc, Perno, Cf, von Schloesser, F, Viale, P, Ceccherini-Silberstein, F, Girardi, E, Lo Caputo, S, Puoti, M, Andreoni, M, Ammassari, A, Balotta, C, Bandera, A, Bonfanti, P, Bonora, S, Borderi, M, Calcagno, A, Calza, L, Capobianchi, Mr, Cingolani, A, Cinque, P, De Luca, A, Di Biagio, A, Gori, A, Guaraldi, G, Lapadula, G, Madeddu, G, Maggiolo, F, Marchetti, G, Marcotullio, S, Monno, L, Nozza, S, Quiros Roldan, E, Rossotti, R, Rusconi, S, Santoro, Mm, Saracino, A, Galli, L, Lorenzini, P, Rodano, A, Shanyinde, M, Carletti, F, Carrara, S, Di Caro, A, Graziano, S, Petrone, F, Prota, G, Quartu, S, Truffa, S, Giacometti, A, Costantini, A, Barocci, V, Angarano, G, Santoro, C, Suardi, C, Donati, V, Verucchi, G, Minardi, C, Quirino, T, Abeli, C, Manconi, Pe, Piano, P, Cacopardo, B, Celesia, B, Vecchiet, J, Falasca, K, Pan, A, Lorenzotti, S, Sighinolfi, L, Segala, D, Vichi, F, Cassola, G, Viscoli, C, Alessandrini, A, Bobbio, N, Mazzarello, G, Mastroianni, C, Belvisi, V, Caramma, I, Chiodera, A, Milini, P, Rizzardini, G, Moioli, Mc, Piolini, R, Ridolfo, Al, Salpietro, S, Tincati, C, Puzzolante, C, Abrescia, N, Chirianni, A, Borgia, G, Orlando, R, Bonadies, G, Di Martino, F, Gentile, I, Maddaloni, L, Cattelan, Am, Marinello, S, Cascio, A, Colomba, C, Baldelli, F, Schiaroli, E, Parruti, G, Sozio, F, Magnani, G, Ursitti, Ma, Cristaudo, A, Baldin, G, Capozzi, M, Cicalini, S, Fontanelli Sulekova, L, Iaiani, G, Latini, A, Mastrorosa, I, Plazzi, Mm, Savinelli, S, Vergori, A, Cecchetto, M, Viviani, F, Bagella, P, Rossetti, B, Franco, A, Fontana Del Vecchio, R, Francisci, D, Di Giuli, C, Caramello, P, Orofino, Gc, Sciandra, M, Bassetti, M, Londero, A, Pellizzer, G, Manfrin, V, Starnini, G, Ialungo, A, Dollet, K, Dellamonica, P, Bernard, E, Courjon, J, Cua, E, De Salvador-Guillouet, F, Durant, J, Etienne, C, Ferrando, S, Mondain-Miton, V, Naqvi, A, Perbost, I, Pillet, S, Prouvost-Keller, B, Pugliese, P, Rio, V, Risso, K, Roger, Pm, Aubert, V, Battegay, M, Bernasconi, E, Böni, J, Braun, Dl, Bucher, H, Ciuffi, A, Dollenmaier, G, Egger, M, Elzi, L, Fehr, J, Fellay, J, Günthard, Hf, Haerry, D, Hasse, B, Hirsch, Hh, Hoffmann, M, Hösli, I, Kahlert, C, Kaiser, L, Keiser, O, Klimkait, T, Kouyos, Rd, Ledergerber, B, Martinetti, G, Martinez de Tejada, B, Marzolini, C, Metzner, Kj, Müller, N, Nicca, D, Pantaleo, G, Paioni, P, Rauch, A, Rudin, C, Scherrer, Au, Speck, R, Stöckle, M, Tarr, P, Trkola, A, Vernazza, P, Wandeler, G, Yerly, S., Infectious diseases, AII - Infectious diseases, APH - Aging & Later Life, Global Health, Paediatric Infectious Diseases / Rheumatology / Immunology, AII - Inflammatory diseases, AII - Amsterdam institute for Infection and Immunity, General Internal Medicine, APH - Quality of Care, Graduate School, Center of Experimental and Molecular Medicine, Medical Microbiology and Infection Prevention, Gastroenterology and Hepatology, ARD - Amsterdam Reproduction and Development, Hatleberg, Camilla I, Ryom, Lene, El-Sadr, Wafaa, Mocroft, Amanda, Reiss, Peter, De Wit, Stephane, Dabis, Francoi, Pradier, Christian, d'Arminio Monforte, Antonella, Kovari, Helen, Law, Matthew, Lundgren, Jens D, Sabin, Caroline A, Dad, Study, Castagna, A, Infektiosairauksien yksikkö, Department of Medicine, Clinicum, HUS Inflammation Center, HUS Internal Medicine and Rehabilitation, MUMC+: DA MMI AIOS (9), MUMC+: DA MMI Infectieserologie (9), Med Microbiol, Infect Dis & Infect Prev, MUMC+: DA MMI Staf (9), RS: FHML non-thematic output, and University of Zurich

Subjects
Male, Cardiovascular disease, gender, cardiovascular disease interventions, cohort studies, HIV, women, myocardial infarction, stroke, Heart disease, Psychological intervention, lnfectious Diseases and Global Health Radboud Institute for Molecular Life Sciences [Radboudumc 4], 030204 cardiovascular system & hematology, Santé publique, ACUTE CORONARY SYNDROME, 10234 Clinic for Infectious Diseases, Cohort Studies, 0302 clinical medicine, Risk Factors, HIV Seropositivity, Medicine and Health Sciences, IN-HOSPITAL MORTALITY, 030212 general & internal medicine, Pathologie maladies infectieuses, Stroke, Research Articles, PRESENTATION, GENERAL-POPULATION, INFECTED PATIENTS, Sex Characteristics, Confounding, Middle Aged, 3. Good health, Infectious Diseases, Cardiovascular Diseases, Cardiovascular disease interventions, Cohort studies, Gender, Hiv, Myocardial infarction, Women, symbols, Female, Cohort study, Research Article, Adult, medicine.medical_specialty, Acute coronary syndrome, ACUTE MYOCARDIAL-INFARCTION, SEX-DIFFERENCES, SYMPTOM PRESENTATION, education, 610 Medicine & health, HEART-DISEASE, NO, INFECTED, 03 medical and health sciences, symbols.namesake, Internal medicine, cardiovascular disease intervention, PATIENTS, medicine, Humans, SYMPTOM, Poisson regression, IN-HOSPITAL, business.industry, MORTALITY, CLINICAL PRESENTATION, Public Health, Environmental and Occupational Health, 2739 Public Health, Environmental and Occupational Health, 2725 Infectious Diseases, medicine.disease, lnfectious Diseases and Global Health Radboud Institute for Health Sciences [Radboudumc 4], 10036 Medical Clinic, 3121 General medicine, internal medicine and other clinical medicine, RISK-FACTORS, Observational study, business, cohort studie
Abstract

There is paucity of data related to potential gender differences in the use of interventions to prevent and treat cardiovascular disease (CVD) among HIV-positive individuals. We investigated whether such differences exist in the observational D:A:D cohort study. Methods: Participants were followed from study enrolment until the earliest of death, six months after last visit or February 1, 2015. Initiation of CVD interventions [lipid-lowering drugs (LLDs), angiotensin-converting enzyme inhibitors (ACEIs), anti-hypertensives, invasive cardiovascular procedures (ICPs) were investigated and Poisson regression models calculated whether rates were lower among women than men, adjusting for potential confounders. Results: Women (n = 12,955) were generally at lower CVD risk than men (n = 36,094). Overall, initiation rates of CVD interventions were lower in women than men; LLDs: incidence rate 1.28 [1.21, 1.35] vs. 2.40 [2.34, 2.46]; ACEIs: 0.88 [0.82, 0.93] vs. 1.43 [1.39, 1.48]; anti-hypertensives: 1.40 [1.33, 1.47] vs. 1.72 [1.68, 1.77] and ICPs: 0.08 [0.06, 0.10] vs. 0.30 [0.28, 0.32], and this was also true for most CVD interventions when exclusively considering periods of follow-up for which individuals were at high CVD risk. In fully adjusted models, women were less likely to receive CVD interventions than men (LLDs: relative rate 0.83 [0.78, 0.88]; ACEIs: 0.93 [0.86, 1.01]; ICPs: 0.54 [0.43, 0.68]), except for the receipt of anti-hypertensives (1.17 [1.10, 1.25]). Conclusion: The use of most CVD interventions was lower among women than men. Interventions are needed to ensure that all HIV-positive persons, particularly women, are appropriately monitored for CVD and, if required, receive appropriate CVD interventions., SCOPUS: ar.j, info:eu-repo/semantics/published

Published
2018

7. Increased risk of cardiovascular disease (CVD) with age in HIV-positive men: A comparison of the D: A: D CVD risk equation and general population CVD risk equations

Author

Reiss, P., Ryom, L., Rickenbach, M., Sabin, C. A., El sadr, W., D'arminio Monforte, A., Phillips, A. N., De Wit, S., Kirk, O., Dabis, F., Pradier, C., Lundgren, J. D., Law, M. G., D:a:d Study Group, CASTAGNA, ANTONELLA, Reiss, P., Ryom, L., Rickenbach, M., Sabin, C. A., El sadr, W., D'arminio Monforte, A., Phillips, A. N., De Wit, S., Kirk, O., Dabis, F., Pradier, C., Lundgren, J. D., Law, M. G., D:a:d Study, Group, and Castagna, Antonella

Subjects
Adult, Male, Risk Factor, Health Policy, Myocardial Infarction, HIV, Anti-HIV Agent, Coronary Disease, Middle Aged, Cardiovascular disease, Regression Analysi, Stroke, Ageing, Prospective Studie, Infectious Diseases, Age Factor, HIV Infection, Pharmacology (medical), Aged, Human
Abstract

Objectives: The aim of the study was to statistically model the relative increased risk of cardiovascular disease (CVD) per year older in Data collection on Adverse events of anti-HIV Drugs (D:A:D) and to compare this with the relative increased risk of CVD per year older in general population risk equations. Methods: We analysed three endpoints: myocardial infarction (MI), coronary heart disease (CHD: MI or invasive coronary procedure) and CVD (CHD or stroke). We fitted a number of parametric age effects, adjusting for known risk factors and antiretroviral therapy (ART) use. The best-fitting age effect was determined using the Akaike information criterion. We compared the ageing effect from D:A:D with that from the general population risk equations: the Framingham Heart Study, CUORE and ASSIGN risk scores. Results: A total of 24323 men were included in analyses. Crude MI, CHD and CVD event rates per 1000 person-years increased from 2.29, 3.11 and 3.65 in those aged 40-45 years to 6.53, 11.91 and 15.89 in those aged 60-65 years, respectively. The best-fitting models included inverse age for MI and age + age2 for CHD and CVD. In D:A:D there was a slowly accelerating increased risk of CHD and CVD per year older, which appeared to be only modest yet was consistently raised compared with the risk in the general population. The relative risk of MI with age was not different between D:A:D and the general population. Conclusions: We found only limited evidence of accelerating increased risk of CVD with age in D:A:D compared with the general population.

Published
2014

8. Development of a definition for Rapid Progression (RP) of renal function in HIV-positive persons: the D:A:D study

Author

Kamara, D.A., Ryom, L., Ross, M., Kirk, O., Reiss, P., Morlat, P., Moranne, O., Fux, C.A., Mocroft, A., Sabin, C., Lundgren, J.D., D:A:D Study Group, the, Posthouwer, D., Smith, C.J., Medische Microbiologie, RS: CAPHRI School for Public Health and Primary Care, and Interne Geneeskunde

Subjects
CHRONIC KIDNEY-DISEASE, FUNCTION DECLINE, Rapid progression, HIV, Kidney disease, urologic and male genital diseases, GLOMERULAR-FILTRATION-RATE, CLASSIFICATION, PREVALENCE, DIET, MORTALITY RISK, INDIVIDUALS, ANTIRETROVIRAL THERAPY, Chronic kidney disease, Estimated glomerular filtration rate, BODY-SURFACE AREA
Abstract

Background: No consensus exists on how to define abnormally rapid deterioration in renal function (Rapid Progression, RP). We developed an operational definition of RP in HIV-positive persons with baseline estimated glomerular filtration rate (eGFR) >90 ml/min/1.73 m(2) (using Cockcroft Gault) in the Data Collection on Adverse Events of Anti-HIV Drugs (D: A: D) study from 2004 to 2011. Methods: Two definitions were evaluated; RP definition A: An average eGFR decline (slope) >= 5 ml/min/1.73 m(2)/year over four years of follow-up with >= 3 eGFR measurements/year, last eGFR = 5 ml/min/1.73 m(2)/year in two consecutive years. RP definition B: An absolute annual decline >= 5 ml/min/1.73 m(2)/year in each year and last eGFR Results: 22,603 individuals had baseline eGFR >= 90 ml/min/1.73 m(2). 108/3655 (3.0%) individuals with >= 4 years' follow-up and >= 3 measurements/year experienced RP under definition A; similar proportions were observed when considering follow-up periods of three (n=195/6375; 3.1%) and two years (n=355/10756; 3.3%). In contrast under RP definition B, greater proportions experienced RP when considering two years (n=476/10756; 4.4%) instead of three (n=48/6375; 0.8%) or four (n=15/3655; 0.4%) years' follow-up. For RP definition A, 13 (12%) individuals who experienced RP progressed to CKD, and only (21) 0.6% of those without RP progressed to CKD (sensitivity 38.2% and specificity 97.4%); whereas for RP definition B, fewer RP individuals progressed to CKD. Conclusions: Our results suggest using three years' follow-up and at least two eGFR measurements per year is most appropriate for a RP definition, as it allows inclusion of a reasonable number of individuals and is associated with the known risk factors. The definition does not necessarily identify all those that progress to incident CKD, however, it can be used alongside other renal measurements to early identify and assess those at risk of developing CKD. Future analyses will use this definition to identify other risk factors for RP, including the role of antiretrovirals.

Published
2014

9. Development of a definition for rapid progression (RP) of renal function in HIV-positive persons:the D:A:D study

Author

Kamara, David A., Ryom, Lene, Ross, Michael, Kirk, Ole, Reiss, Peter, Morlat, Philippe, Moranne, Olivier, Fux, Christoph A., Mocroft, Amanda, Sabin, Caroline, Lundgren, Jens D., Smith, Colette J, D:A:D study, Group., Quiros, Roldan, Powderly B, M. E., Shortman, N, Moecklinghoff, C, Reilly, G, Franquet, X, Ryom, L, Sabin, Ca, Kamara, D, Smith, C, Phillips, A, Mocroft, A, Tverland, J, Mansfeld, M, Nielsen, J, Raben, D, Lundgren, Jd, Brandt, R, Rickenbach, M, Fanti, I, Krum, E, Hillebregt, M, Geffard, S, Sundström, A, Delforge, M, Fontas, E, Torres, F, Mcmanus, H, Wright, S, Kjær, J, Sjøl, A, Meidahl, P, Helweg-Larsen, J, Iversen, J, Kirk, O, Reiss, P, Ross, M, Fux, Ca, Morlat, P, Moranne, O, Kesselring, Am, Kamara, Da, Weber, R, Pradier, C, Friis-Møller, N, Kowalska, J, Sabin, C, Law, M, d'Arminio Monforte, A, Dabis, F, Bruyand, M, Bower, M, Fätkenheuer, G, Donald, A, Grulich, A, Zaheri, S, Gras, L, Prins, Jm, Kuijpers, Tw, Scherpbier, Hj, van der Meer JT, Wit, Fw, Godfried, Mh, van der Poll, D, Nellen, Fj, Lange, Jm, Geerlings, Se, van Vugt, M, Pajkrt, D, Bos, D, van der Valk, D, Grijsen, Ml, Wiersinga, Wj, Goorhuis, A, Hovius, Jw, Lowe, S, Lashof, A, Posthouwer, D, Ammerlaan, Hs, Pronk, Mj, van der Ende ME, de Vries-Sluijs TE, Schurink, Ca, Nouwen, Jl, Verbon, A, Rijnders, Bj, van Gorp EC, van der Feltz, M, Driessen, Gj, van Rossum AM, Branger, J, Schippers, F, van Nieuwkoop, C, van Elzakker EP, Groeneveld, Ph, Bouwhuis, Jw, Soetekouw, R, ten Kate RW, Kroon, Fp, van Dissel JT, Arend, Sm, de Boer MG, Jolink, H, ter Vollaard HJ, Bauer, Mp, den Hollander JG, Pogany, K, van Twillert, D, Kortmann, W, Stuart, Jw, Diederen, Bm, Leyten, Ms, Gelinck, Lb, Kootstra, Gj, Delsing, Ce, Brinkman, K, Blok, Wl, Frissen, Ph, Schouten, We, van den Berk GE, van Kasteren ME, Brouwer, Ae, Veenstra, J, Lettinga, Kd, Mulder, Jw, Vrouenraets, Sm, Lauw, Fn, van Eeden, A, Verhagen, Dw, Sprenger, Hg, Doedens, R, Scholvinck, Eh, van Assen, S, Bierman, Wf, Koopmans, Pp, Keuter, M, van der Ven AJ, ter Hofstede HJ, Dofferhoff, As, Warris, A, van Crevel, R, Hoepelman, Ai, Mudrikova, T, Schneider, Mm, Ellerbroek, Pm, Oosterheert, Jj, Arends, Je, Wassenberg, Mw, Barth, Re, van Agtmael, M, Perenboom, Rm, Claessen, Fa, Bomers, M, Peters, Ej, Geelen, Sp, Wolfs, Tf, Bont, Lj, Richter, C, van der Berg JP, Gisolf, Eh, van den Berge, M, Stegeman, A, van Vonderen MG, van Houte DP, Weijer, S, el Moussaoui, R, Winkel, C, Muskiet, F, Durand, Voigt, R, Chêne, G, Lawson-Ayayi, S, Thiébaut, R, Bonnal, F, Bonnet, F, Bernard, N, Caunègre, L, Cazanave, C, Ceccaldi, J, Chambon, D, Chossat, I, Dauchy, Fa, De Witte, S, Dupon, M, Duffau, P, Dutronc, H, Farbos, S, Gaborieau, V, Gemain, Mc, Gerard, Y, Greib, C, Hessamfar, M, Lacoste, D, Lataste, P, Lafarie, S, Lazaro, E, Malvy, D, Meraud, Jp, Mercié, P, Monlun, E, Neau, D, Ochoa, A, Pellegrin, Jl, Pistone, T, Ragnaud, Jm, Receveur, Mc, Tchamgoué, S, Vandenhende, Ma, Viallard, Jf, Moreau, Jf, Pellegrin, I, Fleury, H, Lafon, Me, Masquelier, B, Trimoulet, P, Breilh, D, Haramburu, F, Miremont-Salamé, G, Blaizeau, Mj, Decoin, M, Delaune, J, Delveaux, S, D'Ivernois, C, Hanapier, C, Leleux, O, Uwamaliya-Nziyumvira, B, Sicard, X, Palmer, G, Touchard, D, Petoumenos, K, Bendall, C, Moore, R, Edwards, S, Hoy, J, Watson, K, Roth, N, Nicholson, J, Bloch, M, Franic, T, Baker, D, Vale, R, Carr, A, Cooper, D, Chuah, J, Ngieng, M, Nolan, D, Skett, J, Calvo, G, Mateu, S, Domingo, P, Sambeat, Ma, Gatell, J, Del Cacho, E, Cadafalch, J, Fuster, M, Codina, C, Sirera, G, Vaqué, A, De Wit, S, Clumeck, N, Necsoi, C, Gennotte, Af, Gerard, M, Kabeya, K, Konopnicki, D, Libois, A, Martin, C, Payen, Mc, Semaille, P, Van Laethem, Y, Neaton, J, Bartsch, G, El-Sadr, Wm, Thompson, G, Wentworth, D, Luskin-Hawk, R, Telzak, E, Abrams, Di, Cohn, D, Markowitz, N, Arduino, R, Mushatt, D, Friedland, G, Perez, G, Tedaldi, E, Fisher, E, Gordin, F, Crane, Lr, Sampson, J, Baxter, J, Lundgren, J, Cozzi-Lepri, A, Grint, D, Podlekareva, D, Peters, L, Reekie, J, Fischer, Ah, Losso, M, Elias, C, Vetter, N, Zangerle, R, Karpov, I, Vassilenko, A, Mitsura, Vm, Suetnov, O, Colebunders, R, Vandekerckhove, L, Hadziosmanovic, V, Kostov, K, Machala, L, Begovac, J, Jilich, D, Sedlacek, D, Kronborg, G, Gerstoft, J, Benfield, T, Larsen, M, Katzenstein, T, Hansen, Ab, Skinhøj, P, Pedersen, C, Ostergaard, L, Zilmer, K, Smidt, J, Ristola, M, Katlama, C, Viard, J, Girard, P, Livrozet, Jm, Vanhems, P, Rockstroh, J, Schmidt, R, van Lunzen, J, Degen, O, Stellbrink, Hj, Staszewski, S, Bickel, M, Kosmidis, J, Gargalianos, P, Xylomenos, G, Perdios, J, Panos, G, Filandras, A, Karabatsaki, E, Sambatakou, H, Banhegyi, D, Mulcahy, F, Yust, I, Turner, D, Burke, M, Pollack, S, Hassoun, G, Maayan, S, Vella, S, Esposito, R, Mazeu, I, Mussini, C, Arici, C, Pristera, R, Mazzotta, F, Gabbuti, A, Vullo, V, Lichtner, M, Chirianni, A, Montesarchio, E, Gargiulo, M, Antonucci, G, Testa, A, Narciso, P, Vlassi, C, Zaccarelli, M, Lazzarin, A, Castagna, A, Gianotti, N, Galli, M, Ridolfo, A, Rozentale, B, Zeltina, I, Chaplinskas, S, Hemmer, R, Staub, T, Ormaasen, V, Maeland, A, Bruun, J, Knysz, B, Gasiorowski, J, Horban, A, Bakowska, E, Grzeszczuk, A, Flisiak, R, Boron-Kaczmarska, A, Pynka, M, Parczewski, M, Beniowski, M, Mularska, E, Trocha, H, Jablonowska, E, Malolepsza, E, Wojcik, K, Antunes, F, Doroana, M, Caldeira, L, Mansinho, K, Maltez, F, Duiculescu, D, Rakhmanova, A, Babes, V, Zakharova, N, Jevtovic, D, Mokráš, M, Staneková, D, Tomazic, J, González-Lahoz, J, Soriano, V, Labarga, P, Medrano, J, Moreno, S, Rodriguez, Jm, Clotet, B, Jou, A, Paredes, R, Tural, C, Puig, J, Bravo, I, Gatell, Jm, Miró, Jm, Gutierrez, M, Karlsson, A, Mateo, G, Flamholc, L, Ledergerber, B, Francioli, P, Cavassini, M, Hirschel, B, Boffi, E, Kravchenko, E, Furrer, H, Battegay, M, Elzi, L, Chentsova, N, Frolov, V, Kutsyna, G, Servitskiy, S, Krasnov, M, Barton, S, Johnson, Am, Mercey, D, Johnson, Ma, Murphy, M, Weber, J, Scullard, G, Fisher, M, Leen, C, Morfeldt, L, Thulin, G, Åkerlund, B, Koppel, K, Håkangård, C, Moroni, M, Angarano, G, Antinori, A, Armignacco, O, Castelli, F, Cauda, R, Di Perri, G, Iardino, R, Ippolito, G, Perno, Cf, von Schloesser, F, Viale, P, Ceccherini-Silberstein, F, Girardi, E, Lo Caputo, S, Puoti, M, Andreoni, M, Ammassari, A, Balotta, C, Bonfanti, P, Bonora, S, Borderi, M, Capobianchi, Mr, Cingolani, A, Cinque, P, De Luca, A, Di Biagio, A, Gori, A, Guaraldi, G, Lapadula, G, Madeddu, G, Maggiolo, F, Marchetti, G, Marcotullio, S, Monno, L, Quiros, E, Rusconi, S, Cicconi, P, Formenti, T, Galli, L, Lorenzini, P, Giacometti, A, Costantini, A, Santoro, C, Suardi, C, Vanino, E, Verucchi, G, Quiros Roldan, E, Minardi, C, Quirino, T, Abeli, C, Manconi, Pe, Piano, P, Vecchiet, J, Falasca, K, Sighinolfi, L, Segala, D, Cassola, G, Viscoli, G, Alessandrini, A, Piscopo, R, Mazzarello, G, Mastroianni, C, Belvisi, V, Caramma, I, Castelli, Ap, Rizzardini, G, Ridolfo, Al, Piolini, R, Salpietro, S, Carenzi, L, Moioli, Mc, Puzzolante, C, Onofrio, M, Abrescia, N, Guida, Mg, Baldelli, F, Francisci, D, Parruti, G, Ursini, T, Magnani, G, Ursitti, Ma, d' Avino, A, Gallo, L, Nicastri, E, Acinapura, R, Capozzi, M, Libertone, R, Tebano, G, Cattelan, A, Mura, Ms, Caramello, P, Orofino, Gc, Sciandra, M, Pellizzer, G, Manfrin, V, Caissotti, C, Dellamonica, P, Bernard, E, Cua, E, De Salvador- Guillouet, F, Durant, J, Ferrando, S, Mondain-Miton, V, Naqvi, A, Perbost, I, Prouvost-Keller, B, Pillet, S, Pugliese, P, Rahelinirina, V, Roger, Pm, Dollet, K, Aubert, V, Barth, J, Bernasconi, E, Böni, J, Bucher, Hc, Burton- Jeangros, C, Calmy, A, Egger, M, Fehr, J, Fellay, J, Gorgievski, M, Günthard, H, Haerry, D, Hasse, B, Hirsch, Hh, Hösli, I, Kahlert, C, Kaiser, L, Keiser, O, Klimkait, T, Kovari, H, Martinetti, G, de Tejada BM, Metzner, K, Müller, N, Nadal, D, Pantaleo, G, Rauch, A, Regenass, A, Rudin, C, Schmid, P, Schultze, D, Schöni-Affolter, F, Schüpbach, J, Speck, R, Taffé, P, Tarr, P, Telenti, A, Trkola, A, Vernazza, P, Yerly, S., AII - Amsterdam institute for Infection and Immunity, APH - Amsterdam Public Health, Global Health, Other departments, Infectious diseases, Paediatric Infectious Diseases / Rheumatology / Immunology, General Internal Medicine, Dermatology, Medical Microbiology and Infection Prevention, Sea to Shore Alliance, University of Florida [Gainesville] (UF), Observatoire des Micro et Nano Technologies (OMNT - UMS 2920), Commissariat à l'énergie atomique et aux énergies alternatives - Laboratoire d'Electronique et de Technologie de l'Information (CEA-LETI), Direction de Recherche Technologique (CEA) (DRT (CEA)), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Direction de Recherche Technologique (CEA) (DRT (CEA)), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Centre National de la Recherche Scientifique (CNRS), Structures et propriétés d'architectures moléculaire (SPRAM - UMR 5819), Institut Nanosciences et Cryogénie (INAC), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019])-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019])-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS), Service de médecine interne et maladies infectieuses [Bordeaux], CHU Bordeaux [Bordeaux]-Groupe hospitalier Saint-André, Département de santé publique, Centre Hospitalier Universitaire de Nice (CHU Nice)-Hôpital Larchet, Service de néphrologie, Hôpital Pasteur [Nice] (CHU)-Centre Hospitalier Universitaire de Nice (CHU Nice), Department of primary care and population sciences, University College of London [London] (UCL), Research Department of Infection and Population Health [London], Economics, Umeå University, Centre National de la Recherche Scientifique (CNRS)-Institut de Chimie du CNRS (INC)-Institut Nanosciences et Cryogénie (INAC), and Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019])-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019])

Subjects
Adult, Male, CHRONIC KIDNEY-DISEASE, Internationality, FUNCTION DECLINE, diagnosis, nephrology, Chronic kidney disease, Estimated glomerular filtration rate, HIV, Kidney disease, Rapid progression, D:A:D study Group, HIV Infections, urologic and male genital diseases, Sensitivity and Specificity, Severity of Illness Index, GLOMERULAR-FILTRATION-RATE, renal insufficiency, NO, MORTALITY RISK, ANTIRETROVIRAL THERAPY, 80 and over, Humans, chronic kidney disease, estimated glomerular filtration rate, hiv, kidney disease, rapid progression, adult, aged, aged, 80 and over, diagnosis, computer-assisted, disease progression, female, glomerular filtration rate, hiv infections, humans, internationality, male, middle aged, renal insufficiency, chronic, reproducibility of results, sensitivity and specificity, algorithms, severity of illness index, Diagnosis, Computer-Assisted, Renal Insufficiency, Chronic, ComputingMilieux_MISCELLANEOUS, BODY-SURFACE AREA, POPULATION, Aged, Aged, 80 and over, INFECTED PATIENTS, Reproducibility of Results, 1103 Clinical Sciences, ASSOCIATION, Urology & Nephrology, Middle Aged, chronic, INDIVIDUALS, [SDV.MP]Life Sciences [q-bio]/Microbiology and Parasitology, computer-assisted, Disease Progression, Female, Algorithms, Research Article, Glomerular Filtration Rate
Abstract

BACKGROUND: No consensus exists on how to define abnormally rapid deterioration in renal function (Rapid Progression, RP). We developed an operational definition of RP in HIV-positive persons with baseline estimated glomerular filtration rate (eGFR) >90 ml/min/1.73 m2 (using Cockcroft Gault) in the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study from 2004 to 2011. METHODS: Two definitions were evaluated; RP definition A: An average eGFR decline (slope) ≥5 ml/min/1.73 m2/year over four years of follow-up with ≥3 eGFR measurements/year, last eGFR

Published
2014

11. Abacavir use and risk of recurrent myocardial infarction.

Author

Sabin, Caroline A., Ryom, Lene, Monforte, Antonella d'Arminio, Hatleberg, Camilla I., Pradier, Christian, El-Sadr, Wafaa, Kirk, Ole, Weber, Rainer, Phillips, Andrew N., Mocroft, Amanda, Bonnet, Fabrice, Law, Matthew, de Wit, Stephane, Reiss, Peter, Lundgren, Jens D., d'Arminio Monforte, Antonella, and D:A:D Study Group

Published
2018
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16. Is there continued evidence for an association between abacavir usage and myocardial infarction risk in individuals with HIV? A cohort collaboration.

Author

Sabin, Caroline A., Reiss, Peter, Ryom, Lene, Phillips, Andrew N., Weber, Rainer, Law, Matthew, Fontas, Eric, Mocroft, Amanda, de Wit, Stephane, Smith, Colette, Dabis, Francois, d'Arminio Monforte, Antonella, El-Sadr, Wafaa, Lundgren, Jens D., and D:A:D Study Group

Subjects
ABACAVIR, MYOCARDIAL infarction risk factors, NUCLEOSIDE reverse transcriptase inhibitors, MYOCARDIAL infarction treatment, MEDICAL care of HIV-positive persons, THERAPEUTICS, ANTI-HIV agents, HIV infection epidemiology, DEOXYRIBONUCLEOSIDES, COMPARATIVE studies, RESEARCH methodology, MEDICAL cooperation, MYOCARDIAL infarction, PHARMACOLOGY, RESEARCH, RESEARCH funding, RISK assessment, LOGISTIC regression analysis, EVALUATION research, ODDS ratio
Abstract

Background: In March 2008, the D:A:D study published results demonstrating an increased risk of myocardial infarction (MI) for patients on abacavir (ABC). We describe changes to the use of ABC since this date, and investigate changes to the association between ABC and MI with subsequent follow-up.Methods: A total of 49,717 D:A:D participants were followed from study entry until the first of an MI, death, 1 February 2013 or 6 months after last visit. Associations between a person's 10-year cardiovascular disease (CVD) risk and the likelihood of initiating or discontinuing ABC were assessed using multivariable logistic/Poisson regression. Poisson regression was used to assess the association between current ABC use and MI risk, adjusting for potential confounders, and a test of interaction was performed to assess whether the association had changed in the post-March 2008 period.Results: Use of ABC increased from 10 % of the cohort in 2000 to 20 % in 2008, before stabilising at 18-19 %. Increases in use pre-March 2008, and subsequent decreases, were greatest in those at moderate and high CVD risk. Post-March 2008, those on ABC at moderate/high CVD risk were more likely to discontinue ABC than those at low/unknown CVD risk, regardless of viral load (≤1,000 copies/ml: relative rate 1.49 [95 % confidence interval 1.34-1.65]; >1,000 copies/ml: 1.23 [1.02-1.48]); no such associations were seen pre-March 2008. There was some evidence that antiretroviral therapy (ART)-naïve persons at moderate/high CVD risk post-March 2008 were less likely to initiate ABC than those at low/unknown CVD risk (odds ratio 0.74 [0.48-1.13]). By 1 February 2013, 941 MI events had occurred in 367,559 person-years. Current ABC use was associated with a 98 % increase in MI rate (RR 1.98 [1.72-2.29]) with no difference in the pre- (1.97 [1.68-2.33]) or post- (1.97 [1.43-2.72]) March 2008 periods (interaction P = 0.74).Conclusions: Despite a reduction in the channelling of ABC for patients at higher CVD risk since 2008, we continue to observe an association between ABC use and MI risk. Whilst confounding cannot be fully ruled out, this further diminishes channelling bias as an explanation for our findings. [ABSTRACT FROM AUTHOR]

Published
2016
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19. Non-AIDS defining cancers in the D:A:D Study--time trends and predictors of survival: a cohort study.

Author

Worm, Signe W, Bower, Mark, Reiss, Peter, Bonnet, Fabrice, Law, Matthew, Fätkenheuer, Gerd, d'Arminio Monforte, Antonella, Abrams, Donald I, Grulich, Andrew, Fontas, Eric, Kirk, Ole, Furrer, Hansjakob, Wit, Stephane De, Phillips, Andrew, Lundgren, Jens D, Sabin, Caroline A, D:A:D Study Group, and De Wit, Stephane

Abstract

Background: Non-AIDS defining cancers (NADC) are an important cause of morbidity and mortality in HIV-positive individuals. Using data from a large international cohort of HIV-positive individuals, we described the incidence of NADC from 2004-2010, and described subsequent mortality and predictors of these.Methods: Individuals were followed from 1st January 2004/enrolment in study, until the earliest of a new NADC, 1st February 2010, death or six months after the patient's last visit. Incidence rates were estimated for each year of follow-up, overall and stratified by gender, age and mode of HIV acquisition. Cumulative risk of mortality following NADC diagnosis was summarised using Kaplan-Meier methods, with follow-up for these analyses from the date of NADC diagnosis until the patient's death, 1st February 2010 or 6 months after the patient's last visit. Factors associated with mortality following NADC diagnosis were identified using multivariable Cox proportional hazards regression.Results: Over 176,775 person-years (PY), 880 (2.1%) patients developed a new NADC (incidence: 4.98/1000PY [95% confidence interval 4.65, 5.31]). Over a third of these patients (327, 37.2%) had died by 1st February 2010. Time trends for lung cancer, anal cancer and Hodgkin's lymphoma were broadly consistent. Kaplan-Meier cumulative mortality estimates at 1, 3 and 5 years after NADC diagnosis were 28.2% [95% CI 25.1-31.2], 42.0% [38.2-45.8] and 47.3% [42.4-52.2], respectively. Significant predictors of poorer survival after diagnosis of NADC were lung cancer (compared to other cancer types), male gender, non-white ethnicity, and smoking status. Later year of diagnosis and higher CD4 count at NADC diagnosis were associated with improved survival. The incidence of NADC remained stable over the period 2004-2010 in this large observational cohort.Conclusions: The prognosis after diagnosis of NADC, in particular lung cancer and disseminated cancer, is poor but has improved somewhat over time. Modifiable risk factors, such as smoking and low CD4 counts, were associated with mortality following a diagnosis of NADC. [ABSTRACT FROM AUTHOR]

Published
2013
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20. High prevalence of the metabolic syndrome in HIV-infected patients: impact of different definitions of the metabolic syndrome

Author

Ferran Torres, Nina Friis-Moller, Roberto CAUDA, Renato Alberto Finazzi, Jens Lundgren, Antonio Chiesi, Clifford Leen, Giuseppe Ippolito, CARLO FEDERICO PERNO, Vicente Soriano, Linos Vandekerckhove, Matti Ristola, Lars Østergaard, Caroline Sabin, Terese L Katzenstein, GUIDO CAMANNI, Bart Rijnders, ANDREA COSTANTINI, AII - Amsterdam institute for Infection and Immunity, APH - Amsterdam Public Health, Infectious diseases, Other departments, Graduate School, General Internal Medicine, Global Health, Worm, Signe W., Friis mã¸ller, Nina, Bruyand, Mathia, Monforte, Antonella D'arminio, Rickenbach, Martin, Reiss, Peter, El sadr, Wafaa, Phillips, Andrew, Lundgren, Jen, Sabin, Caroline, D:a:d Study, Group, Castagna, Antonella, Worm SW, Friis-Møller N, Bruyand M, D'Arminio Monforte A, Rickenbach M, Reiss P, El-Sadr W, Phillips A, Lundgren J, Sabin C, and D:A:D study group, Verucchi G

Subjects
Male, Pediatrics, Epidemiology, Prevalence, hiv, HIV Infections, Cohort Studies, Observational study, Immunology and Allergy, Medicine, HIV Infection, Prospective Studies, epidemiology, metabolic syndrome, observational study, Prospective cohort study, Hypolipidemic Agents, Metabolic Syndrome, education.field_of_study, Hypolipidemic Agent, Metabolic Syndrome X, Middle Aged, Settore MED/07 - Microbiologia e Microbiologia Clinica, Metabolic syndrome, Pathogenesis and modulation of inflammation [N4i 1], Antihypertensive Agent, Infectious Diseases, Cohort, Female, Human, Cohort study, United State, Adult, medicine.medical_specialty, Immunology, Population, Humans, education, Antihypertensive Agents, business.industry, Poverty-related infectious diseases [N4i 3], HIV, CD4 lymphocyte count, middle aged, HIV infections, female, hypolipidemic agents, antihypertensive agents, humans, prevalence, prospective studies, cohort studies, HIV-1, metabolic syndrome X, united states, adult, medicine.disease, Obesity, United States, CD4 Lymphocyte Count, Prospective Studie, epidemiology HIV metabolic syndrome observational study combination antiretroviral therapy cardiovascular-disease lipid profiles association population cohort guidelines management components statement, Cohort Studie, business
Abstract

Contains fulltext : 88346.pdf (Publisher’s version ) (Closed access) INTRODUCTION: This study describes the characteristics of the metabolic syndrome in HIV-positive patients in the Data Collection on Adverse Events of Anti-HIV Drugs study and discusses the impact of different methodological approaches on estimates of the prevalence of metabolic syndrome over time. METHODS: We described the prevalence of the metabolic syndrome in patients under follow-up at the end of six calendar periods from 2000 to 2007. The definition that was used for the metabolic syndrome was modified to take account of the use of lipid-lowering and antihypertensive medication, measurement variability and missing values, and assessed the impact of these modifications on the estimated prevalence. RESULTS: For all definitions considered, there was an increasing prevalence of the metabolic syndrome over time, although the prevalence estimates themselves varied widely. Using our primary definition, we found an increase in prevalence from 19.4% in 2000/2001 to 41.6% in 2006/2007. Modification of the definition to incorporate antihypertensive and lipid-lowering medication had relatively little impact on the prevalence estimates, as did modification to allow for missing data. In contrast, modification to allow the metabolic syndrome to be reversible and to allow for measurement variability lowered prevalence estimates substantially. DISCUSSION: The prevalence of the metabolic syndrome in cohort studies is largely based on the use of nonstandardized measurements as they are captured in daily clinical care. As a result, bias is easily introduced, particularly when measurements are both highly variable and may be missing. We suggest that the prevalence of the metabolic syndrome in cohort studies should be based on two consecutive measurements of the laboratory components in the syndrome definition.

Published
2010

21. Short-term weight gain after antiretroviral therapy initiation and subsequent risk of cardiovascular disease and diabetes: The D: A: D study

Author

Achhra, A. C, Mocroft, A., Reiss, P., Sabin, C., Ryom, L., de Wit, S., Smith, C. J., d'Arminio Monforte, A., Phillips, A., Weber, R., Lundgren, J., Law, M. G., Francisci, Daniela, Baldelli, Franco, Achhra, A. C., Mocroft, A., Reiss, P., Sabin, C., Ryom, L., De Wit, S., Smith, C. J., D'Arminio Monforte, A., Phillips, A., Weber, R., Lundgren, J., Law, M. G., on behalf of the D:a:d Study, Group, Castagna, A, The Kirby Institute for Infection and Immunity in Society (UNSW), University of New South Wales [Sydney] (UNSW), Rigshospitalet [Copenhagen], Copenhagen University Hospital, Achhra, A, Mocroft, A, Reiss, P, Sabin, C, Ryom, L, de Wit, S, Smith, C, d'Arminio Monforte, A, Phillips, A, Weber, R, Lundgren, J, Law, M, and Gori, A

Subjects
Adult, Male, Anti-HIV Agents, Infectious Disease, HIV Infections, Diabete, NO, Body Mass Index, Cohort Studies, Highly active antiretroviral therapy, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Risk Factors, Body mass index, Cardiovascular diseases, Diabetes, HIV, Inflammation, Myocardial infarction, Weight gain, Diabetes Mellitus, Humans, HIV Infection, Pharmacology (medical), Obesity, body mass index, cardiovascular diseases, diabetes, highly active antiretroviral therapy, inflammation, myocardial infarction, weight gain, Risk Factor, Health Policy, Anti-HIV Agent, Diabetes Mellitu, Middle Aged, Cardiovascular disease, Infectious Diseases, Cardiovascular Diseases, Female, Cohort Studie, Human
Abstract

International audience; OBJECTIVES:The aim of the study was to assess the impact of the gain in body mass index (BMI) observed immediately after antiretroviral therapy (ART) initiation on the subsequent risk of cardiovascular disease (CVD) and diabetes.METHODS:We analysed data from the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) cohort study. Outcomes were development of (i) CVD (composite of myocardial infarction/stroke/coronary procedure) and (ii) diabetes. The main exposure variable was change in BMI from ART initiation (pre-ART) to 1 year after initiation (continuous variable) in treatment-naïve individuals initiating ART with no history of CVD or diabetes (for respective outcomes). BMI [weight (kg)/(height (m))(2)] was categorized as underweight (< 18.5), normal (18.5-25), overweight (25-30) and obese (> 30). Poisson regression models were fitted stratified for each pre-ART BMI category to allow for category-specific estimates of incidence rate ratio (IRR). Models were adjusted for pre-ART BMI and CD4 count, key known risk factors (time-updated where possible) and calendar year.RESULTS:A total of 97 CVD events occurred in 43,982 person-years (n = 9321) and 125 diabetes events in 43,278 person-years (n = 9193). In fully adjusted analyses for CVD, the IRR/unit gain in BMI (95% confidence interval) in the first year of ART, by pre-ART BMI category, was: underweight, 0.90 (0.60-1.37); normal, 1.18 (1.05-1.33); overweight, 0.87 (0.70-1.10), and obese, 0.95 (0.71-1.28) (P for interaction = 0.04). For diabetes, the IRR/unit gain in BMI was 1.11 (95% confidence interval 1.03 to 1.21), regardless of pre-ART BMI (P for interaction > 0.05).CONCLUSIONS:Short-term gain in BMI following ART initiation appeared to increase the longer term risk of CVD, but only in those with pre-ART BMI in the normal range. It was also associated with increased risk of diabetes regardless of pre-ART BMI.

Published
2016

22. Cancer risk and use of protease inhibitor or nonnucleoside reverse transcriptase inhibitor-based combination antiretroviral therapy: the D: A: D study

Author

Adilia Warris, Ferran Torres, Nina Friis-Moller, Roberto CAUDA, Hamish McManus, Jens Lundgren, Clifford Leen, Giuseppe Ippolito, CARLO FEDERICO PERNO, Vicente Soriano, Gianpiero Tebano, Daniela Segala, Matti Ristola, Lars Østergaard, Caroline Sabin, Terese L Katzenstein, Bart Rijnders, Agnes LIBOIS, ANDREA COSTANTINI, Robert Colebunders, Bruyand, M, Ryom, L, Shepherd, L, Fatkenheuer, G, Grulich, A, Reiss, P, De Wit, S, Darminio Monforte, A, Furrer, H, Pradier, C, Lundgren, J, Sabin, C, Gori, A, Internal Medicine, Medical Microbiology & Infectious Diseases, Virology, Pediatrics, AII - Amsterdam institute for Infection and Immunity, APH - Amsterdam Public Health, Global Health, Other departments, Infectious diseases, Paediatric Infectious Diseases / Rheumatology / Immunology, General Internal Medicine, Center of Experimental and Molecular Medicine, Graduate School, Dermatology, Medical Microbiology and Infection Prevention, d'Arminio Monforte, A, D:a:d Study, Group, Castagna, Antonella, Lazzarin, A, Medische Microbiologie, RS: NUTRIM - R3 - Chronic inflammatory disease and wasting, Interne Geneeskunde, and RS: CAPHRI - R4 - Health Inequities and Societal Participation

Subjects
Oncology, Male, antiretroviral therapy, cancer, HIV, risk, Protease Inhibitor, lnfectious Diseases and Global Health Radboud Institute for Molecular Life Sciences [Radboudumc 4], HIV Infections, Cancer risk, Protease Inhibitor, Nonnucleoside Reverse Transcriptase Inhibitor, Antiretroviral therapy, HIV, Rate ratio, immune system diseases, Neoplasms, Antiretroviral Therapy, Highly Active, HIV Infection, Pharmacology (medical), Prospective Studies, Prospective cohort study, Immunodeficiency, Reverse-transcriptase inhibitor, Incidence (epidemiology), Incidence, Medicine (all), virus diseases, Middle Aged, 3. Good health, Reverse Transcriptase Inhibitor, Infectious Diseases, Reverse Transcriptase Inhibitors, Female, Adult, Follow-Up Studies, Humans, Protease Inhibitors, Risk Assessment, medicine.drug, Human, medicine.medical_specialty, Infectious Disease, NO, Follow-Up Studie, SDG 3 - Good Health and Well-being, Internal medicine, medicine, Anal cancer, Highly Active, business.industry, Cancer, medicine.disease, Lymphoma, Prospective Studie, Immunology, Neoplasm, business
Abstract

Item does not contain fulltext BACKGROUND: The association between combination antiretroviral therapy (cART) and cancer risk, especially regimens containing protease inhibitors (PIs) or nonnucleoside reverse transcriptase inhibitors (NNRTIs), is unclear. METHODS: Participants were followed from the latest of D:A:D study entry or January 1, 2004, until the earliest of a first cancer diagnosis, February 1, 2012, death, or 6 months after the last visit. Multivariable Poisson regression models assessed associations between cumulative (per year) use of either any cART or PI/NNRTI, and the incidence of any cancer, non-AIDS-defining cancers (NADC), AIDS-defining cancers (ADC), and the most frequently occurring ADC (Kaposi sarcoma, non-Hodgkin lymphoma) and NADC (lung, invasive anal, head/neck cancers, and Hodgkin lymphoma). RESULTS: A total of 41,762 persons contributed 241,556 person-years (PY). A total of 1832 cancers were diagnosed [incidence rate: 0.76/100 PY (95% confidence interval: 0.72 to 0.79)], 718 ADC [0.30/100 PY (0.28-0.32)], and 1114 NADC [0.46/100 PY (0.43-0.49)]. Longer exposure to cART was associated with a lower ADC risk [adjusted rate ratio: 0.88/year (0.85-0.92)] but a higher NADC risk [1.02/year (1.00-1.03)]. Both PI and NNRTI use were associated with a lower ADC risk [PI: 0.96/year (0.92-1.00); NNRTI: 0.86/year (0.81-0.91)]. PI use was associated with a higher NADC risk [1.03/year (1.01-1.05)]. Although this was largely driven by an association with anal cancer [1.08/year (1.04-1.13)], the association remained after excluding anal cancers from the end point [1.02/year (1.01-1.04)]. No association was seen between NNRTI use and NADC [1.00/year (0.98-1.02)]. CONCLUSIONS: Cumulative use of PIs may be associated with a higher risk of anal cancer and possibly other NADC. Further investigation of biological mechanisms is warranted.

Published
2015

23. Trends in underlying causes of death in people with HIV from 1999 to 2011 (D:A:D): a multicohort collaboration

Author

Ferran Torres, Roberto CAUDA, Hamish McManus, Jens Lundgren, Clifford Leen, Giuseppe Ippolito, CARLO FEDERICO PERNO, Vicente Soriano, Sergio Lo Caputo, Matthew Law, Linos Vandekerckhove, Colette Smith, Matti Ristola, Antonella D'Arminio Monforte, Lars Østergaard, Justyna Kowalska, Caroline Sabin, Terese L Katzenstein, GUIDO CAMANNI, Bart Rijnders, Agnes LIBOIS, ANDREA COSTANTINI, Robert Colebunders, University of Zurich, Smith, Colette J, AII - Amsterdam institute for Infection and Immunity, APH - Amsterdam Public Health, Global Health, Other departments, Infectious diseases, Paediatric Infectious Diseases / Rheumatology / Immunology, Other Research, Obstetrics and Gynaecology, General Internal Medicine, Center of Experimental and Molecular Medicine, Medical Microbiology and Infection Prevention, Smith, Colette J., Ryom, Lene, Weber, Rainer, Morlat, Philippe, Pradier, Christian, Reiss, Peter, Kowalska, Justyna D., De Wit, Stephane, Law, Matthew, Sadr, Wafaael, Kirk, Ole, Friis moller, Nina, D'arminio Monforte, Antonella, Phillips, Andrew N., Sabin, Caroline A., Lundgren, Jens D., D:a:d Study, Group, Castagna, Antonella, Med Microbiol, Infect Dis & Infect Prev, RS: CAPHRI School for Public Health and Primary Care, Interne Geneeskunde, and RS: CAPHRI - Public Health: Infectious diseases and antibiotic resistance

Subjects
Adult, Male, Pediatrics, medicine.medical_specialty, Population, lnfectious Diseases and Global Health Radboud Institute for Molecular Life Sciences [Radboudumc 4], 610 Medicine & health, HIV Infections, 2700 General Medicine, 10234 Clinic for Infectious Diseases, symbols.namesake, Liver disease, Risk Factors, Cause of Death, Medicine, Humans, Poisson regression, Poisson Distribution, education, Adverse effect, Cause of death, education.field_of_study, Acquired Immunodeficiency Syndrome, business.industry, Mortality rate, Medicine (all), Australia, General Medicine, Hepatitis C, Middle Aged, medicine.disease, United States, Europe, lnfectious Diseases and Global Health Radboud Institute for Health Sciences [Radboudumc 4], symbols, Female, business, Cause of Death/ trends, Europe/epidemiology, HIV Infections/ mortality, Cohort study
Abstract

Contains fulltext : 137128.pdf (Publisher’s version ) (Closed access) BACKGROUND: With the advent of effective antiretroviral treatment, the life expectancy for people with HIV is now approaching that seen in the general population. Consequently, the relative importance of other traditionally non-AIDS-related morbidities has increased. We investigated trends over time in all-cause mortality and for specific causes of death in people with HIV from 1999 to 2011. METHODS: Individuals from the Data collection on Adverse events of anti-HIV Drugs (D:A:D) study were followed up from March, 1999, until death, loss to follow-up, or Feb 1, 2011, whichever occurred first. The D:A:D study is a collaboration of 11 cohort studies following HIV-1-positive individuals receiving care at 212 clinics in Europe, USA, and Australia. All fatal events were centrally validated at the D:A:D coordinating centre using coding causes of death in HIV (CoDe) methodology. We calculated relative rates using Poisson regression. FINDINGS: 3909 of the 49,731 D:A:D study participants died during the 308,719 person-years of follow-up (crude incidence mortality rate, 12.7 per 1000 person-years [95% CI 12.3-13.1]). Leading underlying causes were: AIDS-related (1123 [29%] deaths), non-AIDS-defining cancers (590 [15%] deaths), liver disease (515 [13%] deaths), and cardiovascular disease (436 [11%] deaths). Rates of all-cause death per 1000 person-years decreased from 17.5 in 1999-2000 to 9.1 in 2009-11; we saw similar decreases in death rates per 1000 person-years over the same period for AIDS-related deaths (5.9 to 2.0), deaths from liver disease (2.7 to 0.9), and cardiovascular disease deaths (1.8 to 0.9). However, non-AIDS cancers increased slightly from 1.6 per 1000 person-years in 1999-2000 to 2.1 in 2009-11 (p=0.58). After adjustment for factors that changed over time, including CD4 cell count, we detected no decreases in AIDS-related death rates (relative rate for 2009-11 vs 1999-2000: 0.92 [0.70-1.22]). However, all-cause (0.72 [0.61-0.83]), liver disease (0.48 [0.32-0.74]), and cardiovascular disease (0.33 [0.20-0.53) death rates still decreased over time. The percentage of all deaths that were AIDS-related (87/256 [34%] in 1999-2000 and 141/627 [22%] in 2009-11) and liver-related (40/256 [16%] in 1999-2000 and 64/627 [10%] in 2009-11) decreased over time, whereas non-AIDS cancers increased (24/256 [9%] in 1999-2000 to 142/627 [23%] in 2009-11). INTERPRETATION: Recent reductions in rates of AIDS-related deaths are linked with continued improvement in CD4 cell count. We hypothesise that the substantially reduced rates of liver disease and cardiovascular disease deaths over time could be explained by improved use of non-HIV-specific preventive interventions. Non-AIDS cancer is now the leading non-AIDS cause and without any evidence of improvement. FUNDING: Oversight Committee for the Evaluation of Metabolic Complications of HAART, with representatives from academia, patient community, US Food and Drug Administration, European Medicines Agency and consortium of AbbVie, Boehringer Ingelheim, Bristol-Myers Squibb, Gilead Sciences, ViiV Healthcare, Merck, Pfizer, F Hoffmann-La Roche, and Janssen Pharmaceuticals.

Published
2014

24. Association between antiretroviral exposure and renal impairment among HIV-positive persons with normal baseline renal function: the D:A:D study

Author

Ryom, L., Mocroft, A., Kirk, O., Worm, S. w., Kamara, D. a., Reiss, P., Ross, M., Fux, C. a., Morlat, P., Moranne, O., Smith, C., Lundgren, J. d., Vullo, Vincenzo, Dabis, F., El Sadr, W., Pradier, C., Weber, R., Law, M., Morfeldt, L., De Wit, S., Calvo, G., D'Arminio Monforte, A., Shortman, N., Butcher, D., Rode, R., Franquet, X., Powderly, W., Sabin, C. a., Phillips, A., Tverland, J., Nielsen, J., Salbol Brandt, R., Rickenbach, M., Fanti, I., Krum, E., Hillebregt, M., Geffard, S., Sundstrom, A., Delforge, M., Fontas, E., Torres, F., Mcmanus, H., Wright, S., Kjaer, J., Sjol, A., Meidahl, P., Helweg Larsen, J., Schmidt Iversen, J., Study Group, D. a. d., Mastroianni, Claudio Maria, Department of primary care and population sciences, University College of London [London] (UCL), Groupement de Recherche et d'Etudes en Gestion à HEC (GREGH), Ecole des Hautes Etudes Commerciales (HEC Paris)-Centre National de la Recherche Scientifique (CNRS), Structures et propriétés d'architectures moléculaire (SPRAM - UMR 5819), Institut Nanosciences et Cryogénie (INAC), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019])-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019])-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS), Observatoire des Micro et Nano Technologies (OMNT - UMS 2920), Commissariat à l'énergie atomique et aux énergies alternatives - Laboratoire d'Electronique et de Technologie de l'Information (CEA-LETI), Direction de Recherche Technologique (CEA) (DRT (CEA)), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Direction de Recherche Technologique (CEA) (DRT (CEA)), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Centre National de la Recherche Scientifique (CNRS), Sea to Shore Alliance, University of Florida [Gainesville] (UF), Service de médecine interne et maladies infectieuses [Bordeaux], CHU Bordeaux [Bordeaux]-Groupe hospitalier Saint-André, Service de néphrologie, Hôpital Pasteur [Nice] (CHU)-Centre Hospitalier Universitaire de Nice (CHU Nice), Département de santé publique, Centre Hospitalier Universitaire de Nice (CHU Nice)-Hôpital Larchet, Economics, Umeå University, Interne Geneeskunde, RS: CAPHRI School for Public Health and Primary Care, Med Microbiol, Infect Dis & Infect Prev, Ryom, L, Mocroft, A, Kirk, O, Worm, S, Kamara, D, Reiss, P, Ross, M, Fux, C, Morlat, P, Moranne, O, Smith, C, Lundgren, J, Gori, A, Centre National de la Recherche Scientifique (CNRS)-Institut de Chimie du CNRS (INC)-Institut Nanosciences et Cryogénie (INAC), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019])-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Ryom, Lene, Mocroft, Amanda, Kirk, Ole, Worm, Signe W., Kamara, David A., Reiss, Peter, Ross, Michael, Fux, Christoph A., Morlat, Philippe, Moranne, Olivier, Smith, Colette, Lundgren, Jens D, D:a:d Study, Group, Castagna, Antonella, AII - Amsterdam institute for Infection and Immunity, APH - Amsterdam Public Health, Global Health, Other departments, Infectious diseases, Paediatric Infectious Diseases / Rheumatology / Immunology, Other Research, Obstetrics and Gynaecology, General Internal Medicine, Center of Experimental and Molecular Medicine, and Medical Microbiology and Infection Prevention

Subjects
Male, HIV Infections, urologic and male genital diseases, Rate ratio, Gastroenterology, Cohort Studies, 0302 clinical medicine, Interquartile range, immune system diseases, eGFR, Immunology and Allergy, HIV Infection, 030212 general & internal medicine, Prospective Studies, Renal Insufficiency, atazanavir, ComputingMilieux_MISCELLANEOUS, 0303 health sciences, Incidence (epidemiology), nephrotoxicity, Incidence, virus diseases, Lopinavir, Middle Aged, ART, chronic kidney disease, HIV, lopinavir, tenofovir, 3. Good health, Pathogenesis and modulation of inflammation [N4i 1], Infectious Diseases, [SDV.MP]Life Sciences [q-bio]/Microbiology and Parasitology, Anti-Retroviral Agents, Female, Poverty-related infectious diseases Infectious diseases and international health [N4i 3], Adult, Glomerular Filtration Rate, Humans, Withholding Treatment, medicine.drug, Human, medicine.medical_specialty, Settore MED/17 - Malattie Infettive, Anti-Retroviral Agents/ administration & dosage/ adverse effects, cohort studies, HIV infections/ drug therapy, Renal function, Infectious Disease, Auto-immunity, transplantation and immunotherapy [N4i 4], NO, Invasive mycoses and compromised host [N4i 2], 03 medical and health sciences, Internal medicine, medicine, 030306 microbiology, business.industry, Poverty-related infectious diseases [N4i 3], medicine.disease, Surgery, Discontinuation, Atazanavir, Prospective Studie, Anti-Retroviral Agent, Cohort Studie, business, Kidney disease
Abstract

Contains fulltext : 125257.pdf (Publisher’s version ) (Closed access) BACKGROUND: Several antiretroviral agents (ARVs) are associated with chronic renal impairment, but the extent of such adverse events among human immunodeficiency virus (HIV)-positive persons with initially normal renal function is unknown. METHODS: D:A:D study participants with an estimated glomerular filtration rate (eGFR) of >/= 90 mL/min after 1 January 2004 were followed until they had a confirmed eGFR of /= 3 months apart. Predictors and eGFR-related ARV discontinuations were identified using Poisson regression. RESULTS: Of 22 603 persons, 468 (2.1%) experienced a confirmed eGFR of /= 90 mL/min. Cumulative tenofovir use (aIRR, 1.18/year [95% CI, 1.12-1.25]) and ritonavir-boosted atazanavir use (aIRR, 1.19/year [95% CI, 1.09-1.32]) were independent predictors of a confirmed eGFR of

Published
2013

25. Associations between immune depression and cardiovascular events in HIV infection

Author

Ferran Torres, Roberto CAUDA, Jens Lundgren, William Powderly, Clifford Leen, Giuseppe Ippolito, CARLO FEDERICO PERNO, Vicente Soriano, Matthew Law, Gianpiero Tebano, Linos Vandekerckhove, Daniela Segala, Matti Ristola, STEFANO VELLA, Antonella D'Arminio Monforte, Lars Østergaard, Caroline Sabin, Terese L Katzenstein, Bart Rijnders, ANDREA COSTANTINI, Sabin, C, Ryom, L, Wit, S, Mocroft, A, Phillips, A, Worm, S, Weber, R, Monforte, A, Reiss, P, Kamara, D, El Sadr, W, Pradier, C, Dabis, F, Law, M, Lundgren, J, Gori, A, University of Zurich, Sabin, Caroline A, Sabin, Caroline A., Ryom, Lene, Wit, Stephane De, Mocroft, Amanda, Phillips, Andrew N., Worm, Signe W., Weber, Rainer, Monforte, Antonella D'arminio, Reiss, Peter, Kamara, David, El sadr, Wafaa, Pradier, Christian, Dabis, Francoi, Law, Matthew, Lundgren, Jen, D:a:d Study, Group, Castagna, Antonella, Amsterdam institute for Infection and Immunity, Amsterdam Public Health, Global Health, Other departments, Infectious diseases, Paediatric Infectious Diseases / Rheumatology / Immunology, Other Research, Obstetrics and Gynaecology, General Internal Medicine, and Center of Experimental and Molecular Medicine

Subjects
Male, HIV Infections, Longitudinal Studie, Cohort Studies, 10234 Clinic for Infectious Diseases, 0302 clinical medicine, CD4+ lymphocyte count, 80 and over, Immunology and Allergy, HIV Infection, 030212 general & internal medicine, Myocardial infarction, Longitudinal Studies, Child, Stroke, Aged, 80 and over, Incidence (epidemiology), Incidence, CD4 Lymphocyte Count, Cardiovascular Diseases/ epidemiology, complications, immunology, Middle Aged, Cardiovascular disease, 3. Good health, Infectious Diseases, Cardiovascular Diseases, Child, Preschool, symbols, Cardiology, 2723 Immunology and Allergy, Female, Cohort study, Human, Adult, medicine.medical_specialty, Adolescent, Immunology, 610 Medicine & health, +, NO, 03 medical and health sciences, symbols.namesake, Young Adult, Bias, Diabetes mellitus, Internal medicine, Bia, medicine, Humans, Poisson regression, cardiovascular diseases, lymphocyte count, Preschool, Aged, 2403 Immunology, business.industry, 2725 Infectious Diseases, medicine.disease, CD4, Confidence interval, Metabolic syndrome, Cohort Studie, business, 030217 neurology & neurosurgery
Abstract

Objective: To consider associations between the latest/nadir CD4 + cell count, and time spent with CD4+ cell count less than 200 cells/ml (duration of immune depression), and myocardial infarction (MI), coronary heart disease (CHD), stroke, or cardiovascular disease (CVD) (CHD or stroke) in 33 301 HIV-positive individuals. Design: Longitudinal cohort study. Methods: Analyses were undertaken using Poisson regression. To investigate whether analyses of stroke were robust to the type of endpoint, we additionally included strokelike events and rejected strokes into the stroke endpoint. Results: Participants experienced 716 MI, 1056 CHD, 303 stroke, and 1284 CVD events. Whereas there was no evidence of a higher MI/CHD risk in those with lower latest/nadir CD4+ cell counts after adjustment [current CD4+

Published
2013

26. Predicting the short-term risk of diabetes in HIV-positive patients: the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study

Author

Roberto CAUDA, Renato Alberto Finazzi, Jens Lundgren, William Powderly, Antonio Chiesi, Clifford Leen, Giuseppe Ippolito, CARLO FEDERICO PERNO, Vicente Soriano, Matthew Law, Linos Vandekerckhove, Matti Ristola, Antonella D'Arminio Monforte, Terese L Katzenstein, GUIDO CAMANNI, Bart Rijnders, ANDREA COSTANTINI, Petoumenos, Kathy, Worm, Signe W, Fontas, Eric, Weber, Rainer, De Wit, Stephane, Bruyand, Mathia, Reiss, Peter, El sadr, Wafaa, Monforte, Antonella D'arminio, Friis møller, Nina, Lundgren, Jens D, Law, Matthew G, D:a:d Study, Group, Castagna, Antonella, Petoumenos, K, Worm, S, Fontas, E, Weber, R, De Wit, S, Bruyand, M, Reiss, P, El Sadr, W, Monforte, A, Friis Møller, N, Lundgren, J, Law, M, Gori, A, Med Microbiol, Infect Dis & Infect Prev, RS: NUTRIM - R3 - Chronic inflammatory disease and wasting, Amsterdam institute for Infection and Immunity, Amsterdam Public Health, Global Health, Other departments, Infectious diseases, Paediatric Infectious Diseases / Rheumatology / Immunology, Other Research, Obstetrics and Gynaecology, General Internal Medicine, Center of Experimental and Molecular Medicine, Medical Microbiology and Infection Prevention, and University of Zurich

Subjects
Male, HIV Infections, 030204 cardiovascular system & hematology, Santé publique, risk equation, 10234 Clinic for Infectious Diseases, MELLITUS, 0302 clinical medicine, Diabetes mellitus, ANTIRETROVIRAL THERAPY, Antiretroviral Therapy, Highly Active, Combination antiretroviral treatment, Medicine and Health Sciences, MULTICENTER AIDS COHORT, HIV Infection, 030212 general & internal medicine, Prospective Studies, adult, anti-HIV agents/administration & dosage/ adverse effects, antiretroviral therapy, highly active/ adverse effects/methods, Decision Support Techniques, Diabetes Mellitus/ chemically induced, drug-related side effects and adverse reactions/ epidemiology, female, HIV Infections/ complications/ drug therapy, humans, male, middle aged, prognosis, prospective studies, risk assessment, Pathologie maladies infectieuses, combination antiretroviral treatment, 2. Zero hunger, LIPODYSTROPHY, education.field_of_study, INFECTED PATIENTS, Framingham Risk Score, virus diseases, Diabetes Mellitu, ASSOCIATION, Middle Aged, Prognosis, 3. Good health, Infectious Diseases, CARDIOVASCULAR-DISEASE, diabetes mellitus, Female, Public Health, Lipodystrophy, Human, Research Article, Adult, medicine.medical_specialty, Drug-Related Side Effects and Adverse Reactions, Prognosi, Anti-HIV Agents, Population, Antiretroviral Therapy, 610 Medicine & health, Risk Assessment, VALIDATION, Risk equation, 03 medical and health sciences, Insulin resistance, Internal medicine, mental disorders, medicine, Humans, Highly Active, Risk factor, education, business.industry, Environmental and Occupational Health, Public Health, Environmental and Occupational Health, Anti-HIV Agent, HIV, 2739 Public Health, Environmental and Occupational Health, 2725 Infectious Diseases, ADULTS, medicine.disease, PROGNOSTIC MODEL, Prospective Studie, Immunology, business, Drug-Related Side Effects and Adverse Reaction, Body mass index, Dyslipidemia
Abstract

Introduction: HIV-positive patients receiving combination antiretroviral therapy (cART) frequently experience metabolic complications such as dyslipidemia and insulin resistance, as well as lipodystrophy, increasing the risk of cardiovascular disease (CVD) and diabetes mellitus (DM). Rates of DM and other glucose-associated disorders among HIV-positive patients have been reported to range between 2 and 14%, and in an ageing HIV-positive population, the prevalence of DM is expected to continue to increase. This study aims to develop a model to predict the short-term (six-month) risk of DM in HIV-positive populations and to compare the existing models developed in the general population. Methods: All patients recruited to the Data Collection on Adverse events of Anti-HIV Drugs (D:A:D) study with follow-up data, without prior DM, myocardial infarction or other CVD events and with a complete DM risk factor profile were included. Conventional risk factors identified in the general population as well as key HIV-related factors were assessed using Poissonregression methods. Expected probabilities of DM events were also determined based on the Framingham Offspring Study DM equation. The D:A:D and Framingham equations were then assessed using an internal-external validation process; area under the receiver operating characteristic (AUROC) curve and predicted DM events were determined. Results: Of 33,308 patients, 16,632 (50%) patients were included, with 376 cases of new onset DM during 89,469 person-years(PY). Factors predictive of DM included higher glucose, body mass index (BMI) and triglyceride levels, and older age. Among HIV-related factors, recent CD4 counts ofB200 cells/mL and lipodystrophy were predictive of new onset DM. The mean performance of the D:A:D and Framingham equations yielded AUROC of 0.894 (95% CI: 0.849, 0.940) and 0.877 (95% CI: 0.823, 0.932), respectively. The Framingham equation over-predicted DM events compared to D:A:D for lower glucose and lower triglycerides, and for BMI levels below 25 kg/m2. Conclusions: The D:A:D equation performed well in predicting the short-term onset of DM in the validation dataset and for specific subgroups provided better estimates of DM risk than the Framingham. Copyright: © 2012 Petoumenos K et al; licensee International AIDS Society., SCOPUS: ar.j, info:eu-repo/semantics/published

Published
2011

27. HIV-induced immunodeficiency and mortality from AIDS-defining and non-AIDS-defining malignancies

Author

Anne Johnson, Andrea Antinori, Ludmila Viksna, Ferran Torres, Adriano LAZZARIN, Roberto CAUDA, Jens Lundgren, LUZ MARTÍN CARBONERO, Frank Van Leth, Antonio Chiesi, Giuseppe Ippolito, CARLO FEDERICO PERNO, Vicente Soriano, Matthew Law, Paolo Bonfanti, Marc Van der Valk, Simon Collins, Patrizio Pezzotti, Kathleen Falster, STEFANO VELLA, Andrea De Luca, Adriana Ammassari, Đorđe Jevtović, Tatiana Katerina Galpérine, Simon Mallal, Raffaele Bruno, Adrian Streinu-Cercel, Thomas Benfield, Viktar M. Mitsura, Caroline Sabin, Terese L Katzenstein, Antonella Castagna, FRANCESCA CECCHERINI SILBERSTEIN, Bart Rijnders, Vassilenko Anna, Alicja Wiercińska-Drapało, Rita Murri, ANDREA COSTANTINI, Amsterdam institute for Infection and Immunity, Amsterdam Public Health, Infectious diseases, Other departments, General Internal Medicine, Global Health, Monforte, Antonella D'arminio, Abrams, Donald, Pradier, Christian, Weber, Rainer, Reiss, Peter, Bonnet, Fabrice, Kirk, Ole, Law, Matthew, De Wit, Stephane, Friis mã¸ller, Nina, Phillips, Andrew N., Sabin, Caroline A., Lundgren, Jens D., Collins, S., Loeliger, E., Tressler, R., Weiler, I., Friis mã¸ller, N., Worm, S. W., Sabin, C. A., Sjã¸l, A., Lundgren, J. D., Sawitz, A., Rickenbach, M., Pezzotti, P., Krum, E., Gras, L., Balestre, E., Sundstrã¶m, A., Poll, B., Fontas, E., Torres, F., Petoumenos, K., Kjã¦r, J. D:a:d Study Group, Castagna, Antonella, University of Zurich, D'Arminio Monforte, A, Internal medicine, and Medical psychology

Subjects
Male, d:a:d study, Lymphoma, HIV Infections, Sex Factor, 10234 Clinic for Infectious Diseases, non-aids-defining malignancies, Neoplasms, Immunology and Allergy, Age Factor, HIV Infection, Young adult, AIDS-Related, Immunodeficiency, Lymphoma, AIDS-Related, hiv infection, Mortality rate, Age Factors, Homosexuality, Middle Aged, AIDS-defining malignancie, Pathogenesis and modulation of inflammation [N4i 1], Infectious Diseases, Epidemiologic Method, 2723 Immunology and Allergy, symbols, Female, Human, Cohort study, Adult, medicine.medical_specialty, Anti-HIV Agents, Immunology, 610 Medicine & health, Article, Drug Administration Schedule, symbols.namesake, Immunocompromised Host, Young Adult, A:D study [D], Sex Factors, Acquired immunodeficiency syndrome (AIDS), Internal medicine, medicine, Humans, Poisson regression, Mortality, aids-defining malignancies, mortality, Homosexuality, Male, Aged, Hepatitis, 2403 Immunology, business.industry, Non-AIDS-defining malignancie, Anti-HIV Agent, 2725 Infectious Diseases, medicine.disease, Confidence interval, CD4 Lymphocyte Count, Neoplasm, Microbial pathogenesis and host defense [UMCN 4.1], business, Epidemiologic Methods
Abstract

Objective: To evaluate deaths from AIDS-defining malignancies (ADM) and non-AIDS-defining malignancies (nADM) in the D:A:D Study and to investigate the relationship between these deaths and immunodeficiency. Design: Observational cohort study. Methods: Patients (23 437) were followed prospectively for 104 921 person-years. We used Poisson regression models to identify factors independently associated with deaths from ADM and nADM. Analyses of factors associated with mortality due to nADM were repeated after excluding nADM known to be associated with a specific risk factor. Results: Three hundred five patients died due to a malignancy, 298 prior to the cutoff for this analysis (ADM: n = 110; nADM: n = 188). The mortality rate due to ADM decreased from 20.1/1000 person-years of follow-up [95% confidence interval (CI) 14.4, 25.9] when the most recent CD4 cell count was

Published
2008

28. Changes over time in risk factors for cardiovascular disease and use of lipid-lowering drugs in HIV-infected individuals and impact on myocardial infarction

Author

Anne Johnson, Ferran Torres, Nina Friis-Moller, Roberto CAUDA, Jens Lundgren, Antonio Chiesi, Matthew Law, Simon Collins, Patrizio Pezzotti, Tatiana Katerina Galpérine, Simon Mallal, Raffaele Bruno, Adrian Streinu-Cercel, Caroline Sabin, Terese L Katzenstein, Bart Rijnders, Alicja Wiercińska-Drapało, Data Collection on Adverse Events of Anti HIV Drugs Study, Group, Sabin, Ca, d'Arminio Monforte, A, Friis Moller, N, Weber, R, El Sadr, Wm, Reiss, P, Kirk, O, Mercie, P, Law, Mg, De Wit, S, Pradier, C, Phillips, An, Lundgren, Jd, Piazza, Marcello, Nappa, Salvatore, Sabin, C, D'Arminio Monforte, A, Friis-Moller, N, El-Sadr, W, Law, M, Phillips, A, Lundgren, J, Mancuso, S, Sabin, Caroline A., D'arminio Monforte, A., Friis moller, N., Weber, R., El sadr, W. M., Reiss, P., Kirk, O., Mercie, P., Law, M. G., De Wit, S., Pradier, C., Phillips, A. N., Lundgren, J. D., D:a:d Study, Group, Castagna, Antonella, AII - Amsterdam institute for Infection and Immunity, APH - Amsterdam Public Health, Infectious diseases, Other departments, General Internal Medicine, Global Health, University of Zurich, and Sabin, C A

Subjects
Adult, Male, Microbiology (medical), medicine.medical_specialty, Anti-HIV Agents, Immunology, antiretroviral therapy, Myocardial Infarction, 610 Medicine & health, HIV Infections, 2726 Microbiology (medical), Article, 10234 Clinic for Infectious Diseases, Coronary artery disease, cardiovascular disease, lipid, Diabetes mellitus, Internal medicine, medicine, Humans, HIV Infection, Myocardial infarction, Adverse effect, Hypolipidemic Agents, Hypolipidemic Agent, business.industry, Incidence, Incidence (epidemiology), Anti-HIV Agent, HIV, 2725 Infectious Diseases, Middle Aged, medicine.disease, Confidence interval, Surgery, Infectious Diseases, Female, business, Body mass index, Dyslipidemia, Human
Abstract

Background. Because of the known relationship between exposure to combination antiretroviral therapy and cardiovascular disease (CVD), it has become increasingly important to intervene against risk of CVD in human immunodeficiency virus (HIV)-infected patients. We evaluated changes in risk factors for CVD and the use of lipid-lowering therapy in HIV-infected individuals and assessed the impact of any changes on the incidence of myocardial infarction. Methods. The Data Collection on Adverse Events of Anti-HIV Drugs Study is a collaboration of 11 cohorts of HIV-infected patients that included follow-up for 33,389 HIV-infected patients from December 1999 through February 2006. Results. The proportion of patients at high risk of CVD increased from 35.3% during 1999-2000 to 41.3% during 2005-2006. Of 28,985 patients, 2801 (9.7%) initiated lipid-lowering therapy; initiation of lipid-lowering therapy was more common for those with abnormal lipid values and those with traditional risk factors for CVD (male sex, older age, higher body mass index [calculated as the weight in kilograms divided by the square of the height in meters], family and personal history of CVD, and diabetes mellitus). After controlling for these, use of lipid-lowering drugs became relatively less common over time. The incidence of myocardial infarction (0.32 cases per 100 person-years [PY]; 95% confidence interval [CI], 0.29-0.35 cases per 100 PY) appeared to remain stable. However, after controlling for changes in risk factors for CVD, the rate decreased over time (relative rate in 2003 [compared with 1999-2000], 0.73 cases per 100 PY [95% CI, 0.50-1.05 cases per 100 PY]; in 2004, 0.64 cases per 100 PY [95% CI, 0.44-0.94 cases per 100 PY]; in 2005-2006, 0.36 cases per 100 PY [95% CI, 0.24-0.56 cases per 100 PY]). Further adjustment for lipid levels attenuated the relative rates towards unity (relative rate in 2003 [compared with 1999-2000], 1.06 cases per 100 PY [95% CI, 0.63-1.77 cases per 100 PY]; in 2004, 1.02 cases per 100 PY [95% CI, 0.61-1.71 cases per 100 PY]; in 2005-2006, 0.63 cases per 100 PY [95% CI, 0.36-1.09 cases per 100 PY]). Conclusions. Although the CVD risk profile among patients in the Data Collection on Adverse Events of Anti-HIV Drugs Study has decreased since 1999, rates have remained relatively stable, possibly as a result of a more aggressive approach towards managing the risk of CVD. © 2008 by the Infectious Diseases Society of America. All rights reserved.

Published
2008

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