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19 results on '"Antiretroviral Therapy Cohort Collaboration (ART-CC)"'

1. Cause-Specific Mortality in HIV-Positive Patients Who Survived Ten Years after Starting Antiretroviral Therapy.

Author

Adam Trickey, Margaret T May, Janne Vehreschild, Niels Obel, Michael John Gill, Heidi Crane, Christoph Boesecke, Hasina Samji, Sophie Grabar, Charles Cazanave, Matthias Cavassini, Leah Shepherd, Antonella d'Arminio Monforte, Colette Smit, Michael Saag, Fiona Lampe, Vicky Hernando, Marta Montero, Robert Zangerle, Amy C Justice, Timothy Sterling, Jose Miro, Suzanne Ingle, Jonathan A C Sterne, and Antiretroviral Therapy Cohort Collaboration (ART-CC)

Subjects
Medicine, Science
Abstract

To estimate mortality rates and prognostic factors in HIV-positive patients who started combination antiretroviral therapy between 1996-1999 and survived for more than ten years.We used data from 18 European and North American HIV cohort studies contributing to the Antiretroviral Therapy Cohort Collaboration. We followed up patients from ten years after start of combination antiretroviral therapy. We estimated overall and cause-specific mortality rate ratios for age, sex, transmission through injection drug use, AIDS, CD4 count and HIV-1 RNA.During 50,593 person years 656/13,011 (5%) patients died. Older age, male sex, injecting drug use transmission, AIDS, and low CD4 count and detectable viral replication ten years after starting combination antiretroviral therapy were associated with higher subsequent mortality. CD4 count at ART start did not predict mortality in models adjusted for patient characteristics ten years after start of antiretroviral therapy. The most frequent causes of death (among 340 classified) were non-AIDS cancer, AIDS, cardiovascular, and liver-related disease. Older age was strongly associated with cardiovascular mortality, injecting drug use transmission with non-AIDS infection and liver-related mortality, and low CD4 and detectable viral replication ten years after starting antiretroviral therapy with AIDS mortality. Five-year mortality risk was

Published
2016
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2. Albumin, white blood cell count, and body mass index improve discrimination of mortality in HIV-positive individuals.

Author

Tate, Janet P, Sterne, Jonathan AC, Justice, Amy C, and Veterans Aging Cohort Study (VACS) and the Antiretroviral Therapy Cohort Collaboration (ART-CC)

Subjects
Veterans Aging Cohort Study (VACS) and the Antiretroviral Therapy Cohort Collaboration, Humans, HIV Infections, Albumins, RNA, Viral, Anti-HIV Agents, Body Mass Index, Leukocyte Count, CD4 Lymphocyte Count, Longitudinal Studies, Predictive Value of Tests, Aging, Adult, Middle Aged, Veterans, Female, Male, Biomarkers, albumin, BMI, cohort study, comorbidity, mortality, prognostic index, validation, Biological Sciences, Medical and Health Sciences, Psychology and Cognitive Sciences, Virology
Abstract

ObjectiveDespite viral suppression and immune response on antiretroviral therapy, people with HIV infection experience excess mortality compared with uninfected individuals. The Veterans Aging Cohort Study (VACS) Index incorporates clinical biomarkers of general health with age, CD4 cell count, and HIV-1 RNA to discriminate mortality risk in a variety of HIV-positive populations. We asked whether additional biomarkers further enhance discrimination.Design and methodsUsing patients from VACS for development and from the Antiretroviral Therapy Cohort Collaboration (ART-CC) for validation, we obtained laboratory values from a randomly selected visit from 2000 to 2014, at least 1 year after antiretroviral therapy initiation. Patients were followed for 5-year, all-cause mortality through September 2016. We fitted Cox models with established predictors and added new predictors based on model fit and Harrell's c-statistic. We converted all variables to continuous functional forms and selected the best model (VACS Index 2.0) for validation in ART-CC patients. We compared discrimination using c-statistics and Kaplan-Meier plots.ResultsAmong 28 390 VACS patients and 12 109 ART-CC patients, 7293 and 722 died, respectively. Nadir CD4, CD8, and CD4 : CD8 ratio did not improve discrimination. Addition of albumin, white blood count, and BMI, improved c-statistics in VACS from 0.776 to 0.805 and in ART-CC from 0.800 to 0.831. Results were robust in all nine ART-CC cohorts, all lengths of follow-up and all subgroups.ConclusionVACS Index 2.0, adding albumin, white blood count, and BMI to version 1.0 and using continuous variables, provides improved discrimination and is highly transportable to external settings.

Published
2019

3. CD4:CD8 Ratio and CD8 Count as Prognostic Markers for Mortality in Human Immunodeficiency Virus–Infected Patients on Antiretroviral Therapy: The Antiretroviral Therapy Cohort Collaboration (ART-CC)

Author

Antiretroviral Therapy Cohort Collaboration (ART-CC), Trickey, Adam, May, Margaret T., Schommers, Philipp, Tate, Jan, Ingle, Suzanne M., Guest, Jodie L., Gill, M. John, Zangerle, Robert, Saag, Mike, Reiss, Peter, Monforte, Antonella d'Arminio, Johnson, Margaret, Lima, Viviane D., Sterling, Tim R., Cavassini, Matthias, Wittkop, Linda, Costagliola, Dominique, and Sterne, Jonathan A. C.

Published
2017

4. Mortality According to CD4 Count at Start of Combination Antiretroviral Therapy Among HIV-infected Patients Followed for up to 15 Years After Start of Treatment: Collaborative Cohort Study

Author

Antiretroviral Therapy Cohort Collaboration (ART-CC), May, Margaret T., Vehreschild, Jorg-Janne, Trickey, Adam, Obel, Niels, Reiss, Peter, Bonnet, Fabrice, Mary-Krause, Murielle, Samji, Hasina, Cavassini, Matthias, Gill, Michael John, Shepherd, Leah C., Crane, Heidi M., Monforte, Antonella d'Arminio, Burkholder, Greer A., Johnson, Margaret M., Sobrino-Vegas, Paz, Domingo, Pere, Zangerle, Robert, Justice, Amy C., Sterling, Timothy R., Miró, José M., and Sterne, Jonathan A. C.

Published
2016

5. Long-term Mortality in HIV-Positive Individuals Virally Suppressed for >3 Years With Incomplete CD4 Recovery

Author

Antiretroviral Therapy Cohort Collaboration (ART-CC), Collaboration of Observational HIV Epidemiological Research Europe (COHERE) in EuroCoord, Engsig, Frederik N., Zangerle, Robert, Katsarou, Olga, Dabis, Francois, Reiss, Peter, Gill, John, Porter, Kholoud, Sabin, Caroline, Riordan, Andrew, Fätkenheuer, Gerd, Gutiérrez, Félix, Raffi, Francois, Kirk, Ole, Mary-Krause, Murielle, Stephan, Christoph, de Olalla, Patricia Garcia, Guest, Jodie, Samji, Hasina, Castagna, Antonella, d'Arminio Monforte, Antonella, Skaletz-Rorowski, Adriane, Ramos, Jose, Lapadula, Giuseppe, Mussini, Cristina, Force, Lluís, Meyer, Laurence, Lampe, Fiona, Boufassa, Foroudy, Bucher, Heiner C., De Wit, Stéphane, Burkholder, Greer A., Teira, Ramon, Justice, Amy C., Sterling, Tim R., Crane, Heidi M., Gerstoft, Jan, Grarup, Jesper, May, Margaret, Chêne, Geneviève, Ingle, Suzanne M., Sterne, Jonathan, and Obel, Niels

Published
2014
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8. Antiretroviral Therapy Cohort Collaboration (ART-CC) investigators. Increased non-AIDS mortality among persons with AIDS-defining events after antiretroviral therapy initiation

Author

Pettit, April C., Giganti, Mark J., Ingle, Suzanne M., May, Margaret T., Shepherd, Bryan E., Gill, Michael J., Fätkenheuer, Gerd, Abgrall, Sophie, Saag, Michael S., Amo, Julia de, Justice, Amy C., Miró Meda, José M., Cavasinni, Matthias, Dabis, François, Monforte, Antonella D., Reiss, Peter, Guest, Jodie, Moore, David, Shepherd, Leah, Obel, Niels, Crane, Heidi M., Smith, Colette, Teira, Ramon, Zangerle, Robert, Sterne, Jonathan A., Sterling, Timothy R., Antiretroviral Therapy Cohort Collaboration (ART-CC), and Universitat de Barcelona

Subjects
Mortalitat, Antiretrovirals, Mortality, Malalts de sida, Antiretroviral agents, AIDS patients
Abstract

Introduction: HIV-1 infection leads to chronic inflammation and to an increased risk of non-AIDS mortality. Our objective was to determine whether AIDS-defining events (ADEs) were associated with increased overall and cause-specific non-AIDS related mortality after antiretroviral therapy (ART) initiation. Methods: We included HIV treatment-na ıve adults from the Antiretroviral Therapy Cohort Collaboration (ART-CC) who initiated ART from 1996 to 2014. Causes of death were assigned using the Coding Causes of Death in HIV (CoDe) protocol. The adjusted hazard ratio (aHR) for overall and cause-specific non-AIDS mortality among those with an ADE (all ADEs, tuberculosis (TB), Pneumocystis jiroveci pneumonia (PJP), and non-Hodgkin's lymphoma (NHL)) compared to those without an ADE was estimated using a marginal structural model. Results: The adjusted hazard of overall non-AIDS mortality was higher among those with any ADE compared to those without any ADE (aHR 2.21, 95% confidence interval (CI) 2.00 to 2.43). The adjusted hazard of each of the cause-specific non-AIDS related deaths were higher among those with any ADE compared to those without, except metabolic deaths (malignancy aHR 2.59 (95% CI 2.13 to 3.14), accident/suicide/overdose aHR 1.37 (95% CI 1.05 to 1.79), cardiovascular aHR 1.95 (95% CI 1.54 to 2.48), infection aHR (95% CI 1.68 to 2.81), hepatic aHR 2.09 (95% CI 1.61 to 2.72), respiratory aHR 4.28 (95% CI 2.67 to 6.88), renal aHR 5.81 (95% CI 2.69 to 12.56) and central nervous aHR 1.53 (95% CI 1.18 to 5.44)). The risk of overall and cause-specific non-AIDS mortality differed depending on the specific ADE of interest (TB, PJP, NHL). Conclusions: In this large multi-centre cohort collaboration with standardized assignment of causes of death, non-AIDS mortality was twice as high among patients with an ADE compared to without an ADE. However, non-AIDS related mortality after an ADE depended on the ADE of interest. Although there may be unmeasured confounders, these findings suggest that a common pathway may be independently driving both ADEs and NADE mortality. While prevention of ADEs may reduce subsequent death due to NADEs following ART initiation, modification of risk factors for NADE mortality remains important after ADE survival.

Published
2018

9. Mortality according to CD4 count at start of combination antiretroviral therapy among HIV positive patients followed for up to 15 years after start of treatment: collaborative cohort study

Author

May, Margaret T, Vehreschild, Jorg-Janne, Trickey, Adam, Obel, Niels, Reiss, Peter, Bonnet, Fabrice, Mary-Krause, Murielle, Samji, Hasina, Cavassini, Matthias, Gill, Michael John, Shepherd, Leah C, Crane, Heidi M, d'Arminio Monforte, Antonella, Burkholder, Greer A, Johnson, Margaret M, Sobrino-Vegas, Paz, Domingo, Pere, Zangerle, Robert, Justice, Amy C, Sterling, Timothy R, Miró, José M, Sterne, Jonathan A C, Antiretroviral Therapy Cohort Collaboration (ART-CC), University of Bristol [Bristol], Universität zu Köln = University of Cologne, University of Copenhagen = Københavns Universitet (UCPH), University of Amsterdam [Amsterdam] (UvA), Academic Medical Center - Academisch Medisch Centrum [Amsterdam] (AMC), Institut de Santé Publique, d'Epidémiologie et de Développement (ISPED), Université Bordeaux Segalen - Bordeaux 2, CHU Bordeaux [Bordeaux], Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Université de Lausanne = University of Lausanne (UNIL), University of Calgary, UCL Medical School, University of Washington [Seattle], 'San Paolo' Hospital, University of Alabama [Tuscaloosa] (UA), Royal Free London NHS Foundation Trust, Instituto Salud Carlos III, Universitat Autònoma de Barcelona (UAB), Universität Innsbruck [Innsbruck], Yale University [New Haven], VA Connecticut Healthcare System, Vanderbilt University [Nashville], Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona (UB), Medical Research Council (Reino Unido), Department for International Development (Reino Unido), National Institute for Health Research (Reino Unido), Agence Nationale de Recherches sur le sida et les hépatites virales (Francia), Institut National de la Santé et de la Recherche Médicale (Francia), Ministère de la Santé (Francia), Ministero della Salute (Italia), Ministerio de Sanidad (España), Swiss National Science Foundation, Ministerio de Ciencia e Innovación (España), Red de Investigación Cooperativa en Investigación en Sida (España), Stichting HIV Monitoring (Netherlands), Unión Europea, National Institutes of Health (Estados Unidos), NIH - National Institute on Alcohol Abuse and Alcoholism (NIAAA) (Estados Unidos), United States Department of Veterans Affairs, Michael Smith Foundation for Health Research, Canadian Institutes of Health Research, Veterans Health Administration, Unión Europea. Comisión Europea. 7 Programa Marco, Government of Alberta (Canadá), Government of Columnia (Estados Unidos), Government of the United Kingdom, Abbott, Gilead Sciences (Spain), Tibotec-Upjohn, ViiV Healthcare, GlaxoSmithKline, Pfizer, Bristol-Myers Squibb, Roche, Boehringer Ingelheim Fonds, Merck, Sharp & Dohme, HAL UPMC, Gestionnaire, Antiretroviral Therapy Cohort Collaboration (ART-CC), Boulle, A., Stephan, C., Miro, JM., Cavassini, M., Chêne, G., Costagliola, D., Dabis, F., Monforte£££Antonella D'Arminio£££ AD., Del Amo, J., Van Sighem, A., Fätkenheuer, G., Gill, J., Guest, J., Haerry, DH., Hogg, R., Justice, A., Shepherd, L., Obel, N., Crane, H., Smith, C., Reiss, P., Saag, M., Sterling, T., Teira, R., Williams, M., Zangerle, R., Sterne, J., May, M., Ingle, S., Trickey, A., Universität zu Köln, University of Copenhagen = Københavns Universitet (KU), Université de Lausanne (UNIL), AII - Amsterdam institute for Infection and Immunity, APH - Amsterdam Public Health, Global Health, and Universitat de Barcelona

Subjects
0301 basic medicine, Male, Integrase inhibitor, HIV Infections, Kaplan-Meier Estimate, Cohort Studies, 0302 clinical medicine, Cohort collaboration, 030212 general & internal medicine, Lymphocytes, [SDV.MP.VIR] Life Sciences [q-bio]/Microbiology and Parasitology/Virology, education.field_of_study, Reverse-transcriptase inhibitor, Relative survival, Mortality rate, Antiretrovirals, Middle Aged, 3. Good health, Antiretroviral therapy, Infectious Diseases, Anti-Retroviral Agents, Cohort, [SDV.MP.VIR]Life Sciences [q-bio]/Microbiology and Parasitology/Virology, HIV/AIDS, Female, medicine.drug, Cohort study, Microbiology (medical), Adult, medicine.medical_specialty, Adolescent, Population, antiretroviral therapy, CD4 count, Limfòcits, 03 medical and health sciences, Young Adult, Internal medicine, medicine, VIH (Virus), Humans, Mortality, education, Survival analysis, business.industry, HIV (Viruses), cohort collaboration, HIV, mortality, Antiretroviral agents, Surgery, CD4 Lymphocyte Count, 030104 developmental biology, Morbiditat, Morbidity, business
Abstract

The strong association of CD4 count at start of combination therapy with subsequent survival in HIV-infected patients diminished during the first 5 years of treatment. After 5 years, lower baseline CD4 counts were not associated with higher mortality., Background. CD4 count at start of combination antiretroviral therapy (ART) is strongly associated with short-term survival, but its association with longer-term survival is less well characterized. Methods. We estimated mortality rates (MRs) by time since start of ART (

Published
2016

10. Mortality of treated HIV-1 positive individuals according to viral subtype in Europe and Canada: collaborative cohort analysis.

Author

Antiretroviral Therapy Cohort Collaboration (ART-CC), Canadian Observational Cohort Collaboration (CANOC), The UK Collaborative HIV Cohort Study (UK CHIC), the Collaboration of Observational HIV Epidemiological Research in Europe (COHERE), Antiretroviral Therapy Cohort Collaboration (ART-CC), Canadian Observational Cohort Collaboration (CANOC), UK Collaborative HIV Cohort Study (UK CHIC), Collaboration of Observational HIV Epidemiological Research in Europe (COHERE), May, Margaret T, Gill, Michael J, Wittkop, Linda, Klein, Marina, Sabin, Caroline, Harrigan, P Richard, Dunn, David, Vehreschild, Jorg Jane, Rubio, Rafael, Mocroft, Amanda, Cavassini, Matthias, Reiss, Peter, Monforte, Antonella D'Arminio, Zangerle, Robert, and Ingle, Suzanne M

Published
2016
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11. Antiretroviral pill count and clinical outcomes in treatment‐naïve patients with HIV infection.

Author

the Antiretroviral Therapy Cohort Collaboration (ART‐CC), Young, J., Bucher, H. C., Zangerle, R., Smith, C., Teira, R., Reiss, P., Jarrín Vera, I., Crane, H., Miro, J. M., D'Arminio Monforte, A., and Saag, M.

Subjects
*AIDS, *CONFIDENCE intervals, *HIV infections, *EVALUATION of medical care, *MORTALITY, *TIME, *ANTIRETROVIRAL agents, *CAUSAL models, *PROPORTIONAL hazards models, *DISEASE progression, *STATISTICAL models, *KAPLAN-Meier estimator, *CONFOUNDING variables
Abstract

Objectives: Treatment guidelines recommend single‐tablet regimens for patients with HIV infection starting antiretroviral therapy. These regimens might be as effective and cost less if taken as separate drugs. We assessed whether the one pill once a day combination of efavirenz, emtricitabine and tenofovir reduces the risk of disease progression compared with multiple‐pill formulations of the same regimen. Methods: We selected treatment‐naïve patients starting one‐, two‐ or three‐pill formulations of this regimen in data from the Antiretroviral Therapy Cohort Collaboration. These patients were followed until an AIDS event or death or until they modified their regimen. We analysed these data using Cox regression models, then used our models to predict the potential consequences of exposing a future population to either a one‐pill regimen or a three‐pill regimen. Results: Among 11 739 treatment‐naïve patients starting the regimen, there were 386 AIDS events and 87 deaths. Follow‐up often ended when patients switched to the same regimen with fewer pills. After the first month, two pills rather than one was associated with an increase in the risk of AIDS or death [hazard ratio (HR) 1.39; 95% confidence interval (CI) 1.01‐1.91], but three pills rather than two did not appreciably add to that increase (HR 1.19; 95% CI 0.84‐1.68). We estimate that 77 patients would need to be exposed to a one‐pill regimen rather than a three‐pill regimen for 1 year to avoid one additional AIDS event or death. Conclusions: This particular single‐tablet regimen is associated with a modest decrease in the risk of AIDS or death relative to multiple‐pill formulations. [ABSTRACT FROM AUTHOR]

Published
2018
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12. Higher rates of AIDS during the first year of antiretroviral therapy among migrants: the importance of tuberculosis.

Author

Shepherd, Bryan Shepherd, Jenkins, Cathy A, Parrish, Deidra D, Glass, Tracy R, Cescon, Angela, Masabeu, Angels, Chene, Genevieve, de Wolf, Frank, Crane, Heidi M, Jarrin, Inma, Gill, John, del Amo, Julia, Abgrall, Sophie, Khaykin, Pavel, Lehmann, Clara, Ingle, Suzanne M, May, Margaret T, Sterne, Jonathan A C, Sterling, Timothy R, and Antiretroviral Therapy Cohort Collaboration (ART-CC)

Published
2013
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13. Durability of first ART regimen and risk factors for modification, interruption or death in HIV-positive patients starting ART in Europe and North America 2002-2009.

Author

Antiretroviral Therapy Cohort Collaboration (ART-CC), Abgrall, Sophie, Ingle, Suzanne M, May, Margaret T, Costagliola, Dominque, Mercie, Patrick, Cavassini, Matthias, Reekie, Joanne, Samji, Hasina, Gill, M John, Crane, Heidi M, Tate, Jan, Sterling, Timothy R, Antinori, Andrea, Reiss, Peter, Saag, Michael S, Mugavero, Michael J, Phillips, Andrew, Manzardo, Christian, and Wasmuth, Jan-Christian

Published
2013
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14. J Acquir Immune Defic Syndr

Author

Daniel Gillor, Lars P. Ryder, Rodolphe Thiébaut, Luuk Gras, Santiago Moreno, Marie Helleberg, Peter Reiss, Michael S. Saag, Margaret T May, Jonathan A C Sterne, Ferdinand W. N. M. Wit, Janet Tate, Niels Obel, Frank de Wolf, Ronald B. Geskus, Colette Smith, José M. Miró, Jodie L. Guest, Dominique Costagliola, Suzanne M Ingle, Matthias Cavassini, Antonella dʼArminio Monforte, Heidi M. Crane, Marta Montero, Timothy R. Sterling, Leah Shepherd, Viviane D. Lima, Christoph Stephan, Adam Trickey, Armin Rieger, John Gill, Antiretroviral Therapy Cohort Collaboration (ART-CC), Stichting HIV Monitoring [Amsterdam], Universiteit van Amsterdam (UvA), University of Bristol [Bristol], University of Copenhagen = Københavns Universitet (KU), Rigshospitalet [Copenhagen], Copenhagen University Hospital, Statistics In System biology and Translational Medicine (SISTM), Inria Bordeaux - Sud-Ouest, Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria)- Bordeaux population health (BPH), 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)-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), Bordeaux population health (BPH), 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), Emory University School of Medicine, Emory University [Atlanta, GA], University of Calgary, University of Washington [Seattle], British Columbia Centre for Excellence in HIV/AIDS [Vancouver], University of British Columbia (UBC), University of Milan, Vanderbilt University Medical Center [Nashville], Vanderbilt University [Nashville], Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona (UB), University of Barcelona, Hospital Universitario Ramón y Cajal [Madrid], Universidad de Alcalá - University of Alcalá (UAH), Universitätsklinikum Frankfurt, Goethe-University Frankfurt am Main, University College of London [London] (UCL), Yale University School of Medicine, University of Alabama at Birmingham [ Birmingham] (UAB), University of Vienna [Vienna], Universität zu Köln, Université de Lausanne (UNIL), Centre Hospitalier Universitaire Vaudois [Lausanne] (CHUV), Hospital Universitari i Politècnic La Fe, University of Amsterdam [Amsterdam] (UvA), Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Sorbonne Université (SU), Amsterdam Institute for Global Health & Development [Amsterdam, The Netherlands], Imperial College London, Public Health Service of Amsterdam, University of Oxford [Oxford], University of Copenhagen = Københavns Universitet (UCPH), Università degli Studi di Milano = University of Milan (UNIMI), Yale School of Medicine [New Haven, Connecticut] (YSM), Universität zu Köln = University of Cologne, Université de Lausanne = University of Lausanne (UNIL), Hospital Universitari i Politècnic La Fe = University and Polytechnic Hospital La Fe, Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), University of Oxford, Gestionnaire, Hal Sorbonne Université, Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria)-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)-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), 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)-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)-Inria Bordeaux - Sud-Ouest, Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria), Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Université de Bordeaux (UB), Graduate School, AII - Infectious diseases, APH - Global Health, APH - Methodology, Global Health, and APH - Aging & Later Life

Subjects
CD8 ratio [CD4], Male, Oncology, Cross-sectional study, CD4:CD8 ratio, [SDV]Life Sciences [q-bio], Cell, Human immunodeficiency virus (HIV), CD4-CD8 Ratio, CD4 cell count, HIV Infections, CD8-Positive T-Lymphocytes, 030312 virology, medicine.disease_cause, MORPH3Eus, Pharmacology (medical), Longitudinal Studies, Young adult, Cd4 cell count, 0303 health sciences, [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, Clinical Science, Middle Aged, Viral Load, SISTM, 3. Good health, Antiretroviral therapy, [SDV] Life Sciences [q-bio], Infectious Diseases, medicine.anatomical_structure, ComputingMethodologies_DOCUMENTANDTEXTPROCESSING, Female, Coll_IDLIC, Adult, medicine.medical_specialty, Adolescent, Anti-HIV Agents, CD8 cell count, antiretroviral therapy, Young Adult, 03 medical and health sciences, Age, Internal medicine, medicine, Coll_ART-CC, Humans, Lymphocyte Count, Anti-HIV Agents/therapeutic use, CD4 Lymphocyte Count, Cross-Sectional Studies, HIV Infections/drug therapy, HIV-1, Viral Load/drug effects, business.industry, HIV, age, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business, CD8, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

Supplemental Digital Content is Available in the Text., Background: An increasing number of HIV-positive individuals now start antiretroviral therapy (ART) with high CD4 cell counts. We investigated whether this makes restoration of CD4 and CD8 cell counts and the CD4:CD8 ratio during virologically suppressive ART to median levels seen in HIV-uninfected individuals more likely and whether restoration depends on gender, age, and other individual characteristics. Methods: We determined median and quartile reference values for CD4 and CD8 cell counts and their ratio using cross-sectional data from 2309 HIV-negative individuals. We used longitudinal measurements of 60,997 HIV-positive individuals from the Antiretroviral Therapy Cohort Collaboration in linear mixed-effects models. Results: When baseline CD4 cell counts were higher, higher long-term CD4 cell counts and CD4:CD8 ratios were reached. Highest long-term CD4 cell counts were observed in middle-aged individuals. During the first 2 years, median CD8 cell counts converged toward median reference values. However, changes were small thereafter and long-term CD8 cell count levels were higher than median reference values. Median 8-year CD8 cell counts were higher when ART was started with

Published
2018

15. Increased non-AIDS mortality among persons with AIDS-defining events after antiretroviral therapy initiation

Author

Peter Reiss, François Dabis, Amy C. Justice, Matthias Cavasinni, Michael Gill, José M. Miró, Suzanne M Ingle, Robert Zangerle, Colette Smith, Heidi M. Crane, Julia del Amo, Antonella d'Arminio Monforte, Jonathan A C Sterne, Sophie Abgrall, Margaret T May, Michael S. Saag, Bryan E. Shepherd, David M. Moore, Jodie L. Guest, Niels Obel, Gerd Fätkenheuer, April C. Pettit, Mark J. Giganti, Leah Shepherd, Ramón Teira, Timothy R. Sterling, AII - Infectious diseases, APH - Aging & Later Life, Infectious diseases, Global Health, AII - Amsterdam institute for Infection and Immunity, Medical Research Council (Reino Unido), Department for International Development (Reino Unido), National Institutes of Health (Estados Unidos), Vanderbilt University Medical Center (Estados Unidos), Ministerio de Sanidad y Consumo (España), Instituto de Salud Carlos III, Red de Investigación Cooperativa en Investigación en Sida (España), Agence Nationale de Recherches sur le sida et les hépatites virales (Francia), Stichting HIV Monitoring (Netherlands), Augustinus Foundation, Antiretroviral Therapy Cohort Collaboration (ART-CC) investigators, and Universitat de Barcelona

Subjects
Male, marginal structural model, 0301 basic medicine, non‐Hodgkin's lymphoma, Marginal structural model, Cohort Studies, 0302 clinical medicine, 030212 general & internal medicine, Research Articles, AIDS patients, Lymphoma, Non-Hodgkin, Pneumonia, Pneumocystis, Hazard ratio, Antiretrovirals, Non-Hodgkin's lymphoma, Middle Aged, 3. Good health, AIDS defining events, Infectious Diseases, tuberculosis, non‐AIDS mortality, Cohort, Female, Research Article, Acquired Immunodeficiency Syndrome/complications, Acquired Immunodeficiency Syndrome/drug therapy, Adult, Anti-HIV Agents/therapeutic use, Humans, Lymphoma, Non-Hodgkin/mortality, Pneumonia, Pneumocystis/mortality, Tuberculosis/mortality, AIDS-defining events, Pneumocystis jiroveci pneumonia, non-AIDS mortality, non-Hodgkin's lymphoma, Cohort study, AIDS‐defining events, medicine.medical_specialty, Tuberculosis, Anti-HIV Agents, 03 medical and health sciences, Acquired immunodeficiency syndrome (AIDS), Internal medicine, Mortalitat, medicine, Mortality, Malalts de sida, Acquired Immunodeficiency Syndrome, business.industry, Public Health, Environmental and Occupational Health, non-Hodgkin’s lymphoma, medicine.disease, Antiretroviral agents, 030112 virology, Confidence interval, Non-AIDS mortality, business
Abstract

INTRODUCTION: HIV-1 infection leads to chronic inflammation and to an increased risk of non-AIDS mortality. Our objective was to determine whether AIDS-defining events (ADEs) were associated with increased overall and cause-specific non-AIDS related mortality after antiretroviral therapy (ART) initiation. METHODS: We included HIV treatment-naïve adults from the Antiretroviral Therapy Cohort Collaboration (ART-CC) who initiated ART from 1996 to 2014. Causes of death were assigned using the Coding Causes of Death in HIV (CoDe) protocol. The adjusted hazard ratio (aHR) for overall and cause-specific non-AIDS mortality among those with an ADE (all ADEs, tuberculosis (TB), Pneumocystis jiroveci pneumonia (PJP), and non-Hodgkin's lymphoma (NHL)) compared to those without an ADE was estimated using a marginal structural model. RESULTS: The adjusted hazard of overall non-AIDS mortality was higher among those with any ADE compared to those without any ADE (aHR 2.21, 95% confidence interval (CI) 2.00 to 2.43). The adjusted hazard of each of the cause-specific non-AIDS related deaths were higher among those with any ADE compared to those without, except metabolic deaths (malignancy aHR 2.59 (95% CI 2.13 to 3.14), accident/suicide/overdose aHR 1.37 (95% CI 1.05 to 1.79), cardiovascular aHR 1.95 (95% CI 1.54 to 2.48), infection aHR (95% CI 1.68 to 2.81), hepatic aHR 2.09 (95% CI 1.61 to 2.72), respiratory aHR 4.28 (95% CI 2.67 to 6.88), renal aHR 5.81 (95% CI 2.69 to 12.56) and central nervous aHR 1.53 (95% CI 1.18 to 5.44)). The risk of overall and cause-specific non-AIDS mortality differed depending on the specific ADE of interest (TB, PJP, NHL). CONCLUSIONS: In this large multi-centre cohort collaboration with standardized assignment of causes of death, non-AIDS mortality was twice as high among patients with an ADE compared to without an ADE. However, non-AIDS related mortality after an ADE depended on the ADE of interest. Although there may be unmeasured confounders, these findings suggest that a common pathway may be independently driving both ADEs and NADE mortality. While prevention of ADEs may reduce subsequent death due to NADEs following ART initiation, modification of risk factors for NADE mortality remains important after ADE survival. We would like to thank the following cohorts for participating in this study; the AIDS Therapy Evaluation Project Netherlands (ATHENA); ANRS CO4 French Hospital Database on HIV (FHDH); ANRS CO3 Aquitaine Cohort, France; Departments of Internal Medicine at University of Cologne and Bonn, Germany; K€oln/Bonn Cohort, Germany; Italian Cohort of Antiretroviral-Na€ıve Patients (ICONA); CORIS, Spain; Proyecto para la Informatizaci on del Seguimiento Cl ınico-epidemiol ogico de la Infecci on por HIV y SIDA (PISCIS), Spain; Royal Free Hospital Cohort, London UK; Swiss HIV Cohort Study (SHCS); The Multicenter Study Group on EuroSIDA; Southern Alberta Clinic, Canada; HIV Atlanta Veterans affairs Cohort Study (HAVACS), USA; UAB 1917 Clinic Cohort, Birmingham, Alabama, USA; Veterans Ageing Cohort Study (VACS8),USA; Vanderbilt- Meharry and Tennessee Center for AIDS Research, Nashville, Tennessee, USA; University of Washington Harborview Medical Center, USA; € Osterreichische HIV-Kohortenstudie (OEHIVKOS), Austria; Danish HIV Cohort Study, Denmark; VACH, (Spain); and HAART Observational Medical Evaluation and Research (HOMER), British Columbia, Canada. We would also like to thank the ART-CC Steering group. Sí

Published
2018

16. CD4:CD8 Ratio and CD8 Count as Prognostic Markers for Mortality in Human Immunodeficiency Virus\textendashInfected Patients on Antiretroviral Therapy: The Antiretroviral Therapy Cohort Collaboration (ART-CC)

Author

Trickey, Adam, May, Margaret T, Schommers, Philipp, Tate, Jan, Ingle, Suzanne M, Guest, Jodie L, Gill, M John, Zangerle, Robert, Saag, Mike, Reiss, Peter, Monforte, Antonella, Johnson, Margaret, Lima, Viviane D, Sterling, Tim R, Cavassini, Matthias, Wittkop, Linda, Costagliola, Dominique, Sterne, Jonathan a C, Boulle, Andrew, Stephan, Christoph, Miró, José M, Chêne, Geneviève, Dabis, François, Monforte, Antonella d'Arminio, Amo, Julia, van Sighem, Ard, Vehreschild, Jorg Janne, Gill, John, Guest, Jodie, Haerry, David Hans-Ulrich, Hogg, Robert, Justice, Amy, Shepherd, Leah, Obel, Niels, Crane, Heidi M, Smith, Colette, Saag, Michael, Sterling, Tim, Teira, Ramon, Williams, Matthew, Sterne, Jonathan, May, Margaret, Ingle, Suzanne, University of Bristol [Bristol], University Hospital of Cologne [Cologne], Yale University [New Haven], Atlanta Veterans Affairs Medical Center [Decatur, GA, États-Unis], University of Calgary, Innsbruck Medical University = Medizinische Universität Innsbruck (IMU), University of Alabama at Birmingham [ Birmingham] (UAB), University of Amsterdam [Amsterdam] (UvA), Amsterdam Institute for Global Health & Development [Amsterdam, The Netherlands], Università degli Studi di Milano = University of Milan (UNIMI), Royal Free London NHS Foundation Trust, University of British Columbia (UBC), Vanderbilt University School of Medicine [Nashville], Lausanne University Hospital, Université de Lausanne = University of Lausanne (UNIL), Epidémiologie et Biostatistique, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), School of Public Health and Family Medicine, University of Cape Town, Universitätsklinikum Frankfurt, CHU Bordeaux [Bordeaux], Team MORPH3EUS (INSERM U1219 - UB - ISPED), Bordeaux population health (BPH), 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)-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), CHU de Bordeaux Pellegrin [Bordeaux], VA Connecticut Healthcare System, Rigshospitalet [Copenhagen], Copenhagen University Hospital, University of Alabama [Tuscaloosa] (UA), AII - Infectious diseases, APH - Aging & Later Life, Global Health, AII - Amsterdam institute for Infection and Immunity, Antiretroviral Therapy Cohort Collaboration (ART-CC), Boulle, A., Stephan, C., Miro, J.M., Cavassini, M., Chêne, G., Costagliola, D., Dabis, F., Monforte, A.D., Del Amo, J., Van Sighem, A., Vehreschild, J.J., Gill, J., Guest, J., Haerry, D.H., Hogg, R., Justice, A., Shepherd, L., Obel, N., Crane, H.M., Smith, C., Reiss, P., Saag, M., Sterling, T., Teira, R., Williams, M., Zangerle, R., Sterne, J., May, M., Ingle, S., and Trickey, A.

Subjects
0301 basic medicine, CD4-Positive T-Lymphocytes, Male, CD4:CD8 ratio, [SDV]Life Sciences [q-bio], CD4-CD8 Ratio, HIV Infections, CD8-Positive T-Lymphocytes, North America/epidemiology, CD8 ratio, CD8 count, HIV, antiretroviral therapy, mortality [CD4], 0302 clinical medicine, Cause of Death, 030212 general & internal medicine, Young adult, Articles and Commentaries, Cause of death, Hazard ratio, Middle Aged, Viral Load, Prognosis, 3. Good health, Europe, Infectious Diseases, Cohort, Female, Viral load, Microbiology (medical), Adult, medicine.medical_specialty, Adolescent, Anti-HIV Agents, HIV Infections/drug therapy, Article, Europe/epidemiology, 03 medical and health sciences, Young Adult, Internal medicine, medicine, Humans, Lymphocyte Count, Aged, Proportional Hazards Models, business.industry, Proportional hazards model, 030112 virology, mortality, Confidence interval, Anti-HIV Agents/therapeutic use, North America, business, Biomarkers, Biomarkers/blood
Abstract

Summary Associations of CD4:CD8 ratio or CD8 count with all-cause and cause-specific mortality were too small for them to be useful as independent prognostic markers in addition to CD4 count in virally suppressed patients on antiretroviral therapy with high CD4 count., Background We investigated whether CD4:CD8 ratio and CD8 count were prognostic for all-cause, AIDS, and non-AIDS mortality in virologically suppressed patients with high CD4 count. Methods We used data from 13 European and North American cohorts of human immunodeficiency virus–infected, antiretroviral therapy (ART)–naive adults who started ART during 1996–2010, who were followed from the date they had CD4 count ≥350 cells/μL and were virologically suppressed (baseline). We used stratified Cox models to estimate unadjusted and adjusted (for sex, people who inject drugs, ART initiation year, and baseline age, CD4 count, AIDS, duration of ART) all-cause and cause-specific mortality hazard ratios for tertiles of CD4:CD8 ratio (0–0.40, 0.41–0.64 [reference], >0.64) and CD8 count (0–760, 761–1138 [reference], >1138 cells/μL) and examined the shape of associations using cubic splines. Results During 276526 person-years, 1834 of 49865 patients died (249 AIDS-related; 1076 non-AIDS-defining; 509 unknown/unclassifiable deaths). There was little evidence that CD4:CD8 ratio was prognostic for all-cause mortality after adjustment for other factors: the adjusted hazard ratio (aHR) for lower vs middle tertile was 1.11 (95% confidence interval [CI], 1.00–1.25). The association of CD8 count with all-cause mortality was U-shaped: aHR for higher vs middle tertile was 1.13 (95% CI, 1.01–1.26). AIDS-related mortality declined with increasing CD4:CD8 ratio and decreasing CD8 count. There was little evidence that CD4:CD8 ratio or CD8 count was prognostic for non-AIDS mortality. Conclusions In this large cohort collaboration, the magnitude of adjusted associations of CD4:CD8 ratio or CD8 count with mortality was too small for them to be useful as independent prognostic markers in virally suppressed patients on ART.

Published
2017

17. Cause-Specific Mortality in HIV-Positive Patients Who Survived Ten Years after Starting Antiretroviral Therapy

Author

Jonathan A C Sterne, Matthias Cavassini, Timothy R. Sterling, Amy C. Justice, Christoph Boesecke, Suzanne M Ingle, Fiona C Lampe, Robert Zangerle, Margaret T May, Victoria Hernando, Heidi M. Crane, Jorg-Janne Vehreschild, Antonella d'Arminio Monforte, Charles Cazanave, Adam Trickey, Colette Smit, José M. Miró, Michael S. Saag, Hasina Samji, Marta Montero, Leah Shepherd, Niels Obel, Sophie Grabar, Michael Gill, Antiretroviral Therapy Cohort Collaboration (ART-CC), University of Bristol [Bristol], Koln University, Köln University, German Centre for Infection Research (DZIF), Partner Site Hamburg, Department of Infectious Diseases [Rigshospitalet], Rigshospitalet [Copenhagen], University of Calgary, University of Washington [Seattle], Rheinische Friedrich-Wilhelms-Universität Bonn, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Cochin [AP-HP], Université Paris Descartes - Paris 5 (UPD5), Groupe hospitalier Pellegrin, Université de Lausanne (UNIL), UCL Medical School, Università degli studi di Milano [Milano], Stichting HIV Monitoring [Amsterdam], Universiteit van Amsterdam (UvA), University of Alabama [Tuscaloosa] (UA), Instituto Salud Carlos III, Hospital La Fe, Innsbruck Medical University [Austria] (IMU), Yale University School of Medicine, Vanderbilt University [Nashville], Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), German Centre for Infection Research - partner site Hamburg-Lübeck-Borstel-Riems (DZIF), Copenhagen University Hospital-Copenhagen University Hospital, Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Università degli Studi di Milano [Milano] (UNIMI), Medical Research Council (Reino Unido), Department for International Development (Reino Unido), Unión Europea, Université de Lausanne = University of Lausanne (UNIL), Università degli Studi di Milano = University of Milan (UNIMI), Innsbruck Medical University = Medizinische Universität Innsbruck (IMU), Yale School of Medicine [New Haven, Connecticut] (YSM), German Centre for Infection Research ( DZIF ), Department of Infectious Diseases [Copenhagen], Rigshospitalet [Copenhagen]-University of Copenhagen ( KU ), Bonn Universität [Bonn], Institut Pierre Louis d'Epidémiologie et de Santé Publique ( iPLESP ), Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Université Pierre et Marie Curie - Paris 6 ( UPMC ), Université Paris Descartes - Paris 5 ( UPD5 ), Université de Lausanne ( UNIL ), Universiteit van Amsterdam ( UvA ), University of Alabama [Tuscaloosa] ( UA ), Innsbruck Medical University [Austria] ( IMU ), and Yale School of Medicine

Subjects
0301 basic medicine, RNA viruses, Male, Pediatrics, Viral Diseases, Cancer Treatment, lcsh:Medicine, HIV Infections, Pathology and Laboratory Medicine, 0302 clinical medicine, Immunodeficiency Viruses, Risk Factors, Medicine and Health Sciences, Medicine, Public and Occupational Health, 030212 general & internal medicine, Young adult, lcsh:Science, [SDV.EE]Life Sciences [q-bio]/Ecology, environment, Multidisciplinary, Transmission (medicine), Mortality rate, Viral Load, Middle Aged, Prognosis, Vaccination and Immunization, 3. Good health, AIDS, Infectious Diseases, Oncology, Medical Microbiology, Viral Pathogens, Cohort, Viruses, Female, Pathogens, Viral load, Cohort study, Research Article, Adult, medicine.medical_specialty, Adolescent, Death Rates, Anti-HIV Agents, Immunology, Antiretroviral Therapy, Microbiology, [ SDV.EE ] Life Sciences [q-bio]/Ecology, environment, 03 medical and health sciences, Young Adult, Acquired immunodeficiency syndrome (AIDS), Antiviral Therapy, Population Metrics, Diagnostic Medicine, Virology, Retroviruses, Humans, Aged, Anti-HIV Agents/pharmacology, Anti-HIV Agents/therapeutic use, Demography, HIV Infections/drug therapy, HIV Infections/mortality, HIV-1/drug effects, HIV-1/physiology, Survival Analysis, Microbial Pathogens, Survival analysis, Population Biology, business.industry, lcsh:R, Lentivirus, Organisms, Biology and Life Sciences, HIV, medicine.disease, 030112 virology, Surgery, People and Places, HIV-1, lcsh:Q, Preventive Medicine, business, Viral Transmission and Infection
Abstract

OBJECTIVES: To estimate mortality rates and prognostic factors in HIV-positive patients who started combination antiretroviral therapy between 1996-1999 and survived for more than ten years. METHODS: We used data from 18 European and North American HIV cohort studies contributing to the Antiretroviral Therapy Cohort Collaboration. We followed up patients from ten years after start of combination antiretroviral therapy. We estimated overall and cause-specific mortality rate ratios for age, sex, transmission through injection drug use, AIDS, CD4 count and HIV-1 RNA. RESULTS: During 50,593 person years 656/13,011 (5%) patients died. Older age, male sex, injecting drug use transmission, AIDS, and low CD4 count and detectable viral replication ten years after starting combination antiretroviral therapy were associated with higher subsequent mortality. CD4 count at ART start did not predict mortality in models adjusted for patient characteristics ten years after start of antiretroviral therapy. The most frequent causes of death (among 340 classified) were non-AIDS cancer, AIDS, cardiovascular, and liver-related disease. Older age was strongly associated with cardiovascular mortality, injecting drug use transmission with non-AIDS infection and liver-related mortality, and low CD4 and detectable viral replication ten years after starting antiretroviral therapy with AIDS mortality. Five-year mortality risk was

Published
2016

18. Influence of Geographical Origin and Ethnicity on Mortality in Patients on Antiretroviral Therapy in Canada, Europe, and the United States

Author

M. John Gill, Cornelia Staehelin, Hasina Samji, François Dabis, Michael J. Mugavero, Frank de Wolf, Daniel Podzamczer, Julia del Amo, Jodie L. Guest, Sophie Abgrall, Jonathan A C Sterne, Antonella Castagna, Heidi M. Crane, Margaret T May, Christoph Boesecke, Inma Jarrín, Amy C. Justice, Suzanne M Ingle, Fiona C Lampe, Timothy R. Sterling, Pavel Khaykin, Antiretroviral Therapy Cohort Collaboration, (ART-CC), and Castagna, Antonella

Subjects
Gerontology, United State, Microbiology (medical), Adult, Male, Canada, Latin Americans, Adolescent, antiretroviral therapy, Ethnic group, Emigrants and Immigrants, HIV Infections, 610 Medicine & health, Kaplan-Meier Estimate, ethnic minoritie, Socioeconomic Factor, Cohort Studies, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Acquired immunodeficiency syndrome (AIDS), Residence Characteristics, Medicine, Humans, 030212 general & internal medicine, 030505 public health, business.industry, Proportional hazards model, Mortality rate, Hazard ratio, Emigrants and Immigrant, medicine.disease, HIV infection, United States, 3. Good health, Europe, migrant, Infectious Diseases, Socioeconomic Factors, Residence Characteristic, Cohort, Female, Cohort Studie, 0305 other medical science, business, Demography, Cohort study, Human
Abstract

Our objective was to assess differences in all-cause mortality, as well as AIDS and non-AIDS death rates, among patients started on antiretroviral therapy (ART) according to their geographical origin and ethnicity/race in Europe, Canada, and the United States. METHODS: This was a collaboration of 19 cohort studies of human immunodeficiency virus-positive subjects who have initiated ART (ART Cohort Collaboration) between 1998 and 2009. Adjusted mortality hazard ratios (AHRs) were estimated using Cox regression. A competing risk framework was used to estimate adjusted subdistribution hazard ratios for AIDS and non-AIDS mortality. RESULTS: Of 46 648 European patients, 16.3% were from sub-Saharan Africa (SSA), 5.1% Caribbean and Latin America, 1.6% North Africa and Middle East, and 1.7% Asia/West; of 1371 patients from Canada, 14.9% were First Nations and 22.4% migrants, and of 7742 patients from North America, 55.5% were African American and 6.6% Hispanic. Migrants from SSA (AHR, 0.79; 95% confidence interval [CI], .68-.92) and Asia/West (AHR, 0.62; 95% CI, .41-.92) had lower mortality than Europeans; these differences appeared mainly attributable to lower non-AIDS mortality. Compared with white Canadians, mortality in Canadian First Nations people (AHR, 1.48; 95% CI, .96-2.29) was higher, both for AIDS and non-AIDS mortality rates. Among US patients, when compared with whites, African Americans had higher AIDS and non-AIDS mortality, and hazard ratios for all-cause mortality increased with time on ART. CONCLUSIONS: The lower mortality observed in migrants suggests "healthy migrant" effects, whereas the higher mortality in First Nations people and African Americans in North America suggests social inequality gaps. KEYWORDS: HIV infection, antiretroviral therapy, ethnic minorities, migrants Comment in Addressing disparities in HIV mortality: antiretroviral therapy is necessary but not sufficient. [Clin Infect Dis. 2013]

Published
2013

19. Heterogeneity in outcomes of treated HIV-positive patients in Europe and North America: relation with patient and cohort characteristics

Author

Consuelo Viladés, Jörg Janne Vehreschild, Federico Pulido, Michael Ohl, INMA JARRIN, Roberto CAUDA, VICTORIA HERNANDO, Mar Masiá, Aba Mahamat, Clifford Leen, Giuseppe Ippolito, Dominique Costagliola, Margaret May, CARLO FEDERICO PERNO, Vicente Soriano, Montserrat Vargas Laguna, Gianpiero Tebano, Linos Vandekerckhove, Michael John Gill, Fiona Lampe, José A. Oteo, Jane Simoni, Daniela Segala, Jonathan Sterne, Matti Ristola, Antonella D'Arminio Monforte, Lars Østergaard, Alexandra Montoliu, Willem Melchers, Lise Cuzin, Sophie Matheron, André Cabié, Terese L Katzenstein, Paz Sobrino-Vegas, Cedric Arvieux, Bart Rijnders, Elisa De Lazzari, Juan Berenguer, Mª Jesus Perez Elias, Carmen Cabellos, ANDREA COSTANTINI, Robert Hogg, Felipe García, University of Zurich, May, Margaret T, May, Margaret T., Hogg, Robert S., Justice, Amy C., Shepherd, Bryan E., Costagliola, Dominique, Ledergerber, Bruno, Thiã©baut, Rodolphe, John Gill, M., Kirk, Ole, Van Sighem, Ard, Saag, Michael S., Navarro, Gemma, Sobrino vegas, Paz, Lampe, Fiona, Ingle, Suzanne, Guest, Jodie L., Crane, Heidi M., D'Arminio, Monforte Antonella, Vehreschild, Jã¶rg J., Sterne, Jonathan A. C., Art_cc, Castagna, Antonella, Epidémiologie, stratégies thérapeutiques et virologie cliniques dans l'infection à VIH, Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), 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), Population Sciences, University College of London [London] (UCL), Institut de recherche en santé, environnement et travail (Irset), Université d'Angers (UA)-Université de Rennes (UR)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Antiretroviral Therapy Cohort Collaboration (ART-CC), May, M, Hogg, R, Justice, A, Shepherd, B, Costagliola, D, Ledergerber, B, Thiébaut, R, John Gill, M, Kirk, O, van Sighem, A, Saag, M, Navarro, G, Sobrino Vegas, P, Lampe, F, Ingle, S, Guest, J, Crane, H, D'Arminio, M, Vehreschild, J, Sterne, J, Gori, A, Université d'Angers (UA)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Ciències Mèdiques Bàsiques, Universitat Rovira i Virgili., Other departments, Amsterdam institute for Infection and Immunity, Infectious diseases, Graduate School, Amsterdam Public Health, General Internal Medicine, Global Health, Center of Experimental and Molecular Medicine, Paediatric Infectious Diseases / Rheumatology / Immunology, Medical Microbiology and Infection Prevention, and Microbes in Health and Disease (MHD)

Subjects
Male, MESH: CD4 Lymphocyte Count, Epidemiology, HIV Infections, Sex Factor, Other Original Articles, 10234 Clinic for Infectious Diseases, 0302 clinical medicine, MESH: Risk Factors, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Risk Factors, HIV Seropositivity, prognostic model, Age Factor, HIV Infection, 030212 general & internal medicine, Young adult, MESH: Aged, 0303 health sciences, MESH: Middle Aged, Mortality rate, Medicine (all), Socio-economic statu, Age Factors, Cohort, General Medicine, cohort, MESH: HIV Infections, Middle Aged, Prognosis, 3. Good health, Antiretroviral therapy, AIDS, Europe, Anti-Retroviral Agents, MESH: Young Adult, Female, Human, Adult, medicine.medical_specialty, Adolescent, Prognosi, Heterogeneity, HIV, Mortality, Prognostic model, Socio-economic status, socio-economic status, antiretroviral therapy, MEDLINE, 610 Medicine & health, MESH: Anti-Retroviral Agents, MESH: Prognosis, NO, 03 medical and health sciences, Young Adult, MESH: HIV Seropositivity, Sex Factors, Acquired immunodeficiency syndrome (AIDS), MESH: Sex Factors, medicine, Humans, Socioeconomic status, Aged, MESH: Acquired Immunodeficiency Syndrome, MESH: Adolescent, MESH: Age Factors, Acquired Immunodeficiency Syndrome, MESH: Humans, 030306 microbiology, business.industry, Risk Factor, MESH: Adult, Acquired Immunodeficiency Syndrome/drug therapy/mortality, Anti-Retroviral Agents/ therapeutic use, CD4 Lymphocyte Count, Europe/epidemiology, HIV Infections/diagnosis/ drug therapy/ mortality, HIV Seropositivity/drug therapy/mortality, North America/epidemiology, Sex Factors Young Adult, medicine.disease, mortality, Confidence interval, MESH: Male, MESH: North America, Immunology, North America, Anti-Retroviral Agent, MESH: Europe, heterogeneity, business, MESH: Female, Demography, 2713 Epidemiology
Abstract

Background: HIV cohort collaborations, which pool data from diverse patient cohorts, have provided key insights into outcomes of antiretroviral therapy (ART). However, the extent of, and reasons for, between-cohort heterogeneity in rates of AIDS and mortality are unclear. Methods: We obtained data on adult HIV-positive patients who started ART from 1998 without a previous AIDS diagnosis from 17 cohorts in North America and Europe. Patients were followed up from 1 month to 2 years after starting ART. We examined between-cohort heterogeneity in crude and adjusted (age, sex, HIV transmission risk, year, CD4 count and HIV-1 RNA at start of ART) rates of AIDS and mortality using random-effects meta-analysis and meta-regression. Results: During 61 520 person-years, 754/38 706 (1.9%) patients died and 1890 (4.9%) progressed to AIDS. Between-cohort variance in mortality rates was reduced from 0.84 to 0.24 (0.73 to 0.28 for AIDS rates) after adjustment for patient characteristics. Adjusted mortality rates were inversely associated with cohorts' estimated completeness of death ascertainment [excellent: 96-100%, good: 90-95%, average: 75-89%; mortality rate ratio 0.66 (95% confidence interval 0.46-0.94) per category]. Mortality rate ratios comparing Europe with North America were 0.42 (0.31-0.57) before and 0.47 (0.30-0.73) after adjusting for completeness of ascertainment. Conclusions: Heterogeneity between settings in outcomes of HIV treatment has implications for collaborative analyses, policy and clinical care. Estimated mortality rates may require adjustment for completeness of ascertainment. Higher mortality rate in North American, compared with European, cohorts was not fully explained by completeness of ascertainment and may be because of the inclusion of more socially marginalized patients with higher mortality risk. © The Author 2012; all rights reserved.

Published
2012

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