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4. Rapid screening of methicillin-resistant Staphylococcus aureus using PCR and chromogenic agar: a prospective study to evaluate costs and effects

Author

Wassenberg, M.W.M., Kluytmans, J.A.J.W., Box, A.T.A., Bosboom, R.W., Buiting, A.G.M., van Elzakker, E.P.M., Melchers, W.J.G., van Rijen, M.M.L., Thijsen, S.F.T., Troelstra, A., Vandenbroucke-Grauls, C.M.J.E., Visser, C.E., Voss, A., Wolffs, P.F.G., Wulf, M.W.H., van Zwet, A.A., de Wit, G.A., and Bonten, M.J.M.

Published
2010
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7. Predictive Performance of Cardiovascular Disease Risk Prediction Algorithms in People Living With HIV

Author

Zoest, R.A. van, Law, M., Sabin, C.A., Vaartjes, I., Valk, M. van der, Arends, J.E., Reiss, P., Wit, F.W., Geerlings, S.E., Godfried, M.H., Goorhuis, A., Hovius, J.W., Kuijpers, T.W., Nellen, F.J.B., Poll, D.T. van der, Prins, J.M., Vugt, H.J.M. van, Wiersinga, W.J., Wit, F.W.M.N., Duinen, M. van, Eden, J. van, Hes, A.M.H. van, Pijnappel, F.J.J., Weijsenfeld, A.M., Jurriaans, S., Back, N.K.T., Zaaijer, H.L., Berkhout, B., Cornelissen, M.T.E., Schinkel, C.J., Wolthers, K.C., Peters, E.J.G., Agtmael, M.A. van, Bomers, M., Heitmuller, M., Laan, L.M., Ang, C.W., Houdt, R. van, Pettersson, A.M., Vandenbroucke-Grauls, C.M.J.E., Berge, M. van den, Stegeman, A., Baas, S., Looff, L.H. de, Wintermans, B., Veenemans, J., Pronk, M.J.H., Ammerlaan, H.S.M., Munnik, E.S. de, Jansz, A.R., Tjhie, J., Wegdam, M.C.A., Deiman, B., Scharnhorst, V., Eeden, A. van, Brokking, W., Groot, M., Elsenburg, L.J.M., Damen, M., Kwa, I.S., Kasteren, M.E.E. van, Brouwer, A.E., Erve, R. van, Kruijf-van de Wiel, B.A.F.M. de, Ven, B. van de, Buiting, A.G.M., Kabel, P.J., Versteeg, D., Ende, M.E. van der, Bax, H.I., Gorp, E.C.M. van, Nouwen, J.L., Rijnders, B.J.A., Schurink, C.A.M., Verbon, A., Vries-Sluijs, T.E.M.S. de, Jong-Peltenburg, N.C. de, Bassant, N., Beek, J.E.A. van, Vriesde, M., Zonneveld, L.M. van, Berg-Cameron, H.J. van den, Groot, J. de, Zeeuw-de Man, M. de, Boucher, C.A.B., Koopmans, M.P.G., Kampen, J.J.A. van, Pas, S.D., Branger, J., Douma, R.A., Duijf-van de Ven, C.J.H.M., Schippers, E.F., Nieuwkoop, C. van, IJperen, J.M. van, Geilings, J., Hut, G. van der, Burgel, N.D. van, Leyten, E.M.S., Gelinck, L.B.S., Davids-Veldhuis, S., Hartingsveld, A.Y. van, Meerkerk, C., Wildenbeest, G.S., Heikens, E., Groeneveld, P.H.P., Bouwhuis, J.W., Lammers, A.J.J., Kraan, S., Hulzen, A.G.W. van, Kruiper, M.S.M., Bliek, G.L. van der, Bor, P.C.J., Bloembergen, P., Wolfhagen, M.J.H.M., Ruijs, G.J.H.M., Kroon, F.P., Boer, M.G.J. de, Scheper, H., Jolink, H., Dorama, W., Holten, N. van, Claas, E.C.J., Wessels, E., Hollander, J.G. den, Pogany, K., Roukens, A., Kastelijns, M., Smit, J.V., Smit, E., Struik-Kalkman, D., Tearno, C., Niekerk, T. van, Pontesilli, O., Lowe, S.H., Lashof, A.M.L.O., Posthouwer, D., Ackens, R.P., Burgers, K., Schippers, J., Weijenberg-Maes, B., Loo, I.H.M. van, Havenith, T.R.A., Mulder, J.W., Vrouenraets, S.M.E., Lauw, F.N., Broekhuizen, M.C. van, Vlasblom, D.J., Smits, P.H.M., Weijer, S., Moussaoui, R. el, Bosma, A.S., Vonderen, M.G.A. van, Kampschreur, L.M., Dijkstra, K., Faber, S., Weel, J., Kootstra, G.J., Delsing, C.E., Burg-van de Plas, M. van der, Heins, H., Kortmann, W., Twillert, G. van, Renckens, R., Ruiter-Pronk, D., Truijen-Oud, F.A. van, Stuart, J.W.T.C., IJzerman, E.P., Jansen, R., Reijden, W.A. van der, Brinkman, K., Berk, G.E.L. van den, Blok, W.L., Frissen, P.H.J., Lettinga, K.D., Schouten, W.E.M., Veenstra, J., Brouwer, C.J., Geerders, G.F., Hoeksema, K., Kleene, M.J., Meche, I.B. van der, Spelbrink, M., Toonen, A.J.M., Wijnands, S., Kwa, D., Regez, R., Crevel, R. van, Keuter, M., Ven, A.J.A.M. van der, Hofstede, H.J.M. ter, Dofferhoff, A.S.M., Hoogerwerf, J., Grintjes-Huisman, K.J.T., Haan, M. de, Marneef, M., Rahamat-Langendoen, J., Stelma, F.F., Burger, D., Gisolf, E.H., Hassing, R.J., Claassen, M., Beest, G. ter, Bentum, P.H.M. van, Langebeek, N., Tiemessen, R., Swanink, C.M.A., Lelyveld, S.F.L. van, Soetekouw, R., Prijt, L.M.M. van der, Swaluw, J. van der, Bermon, N., Herpers, B.L., Veenendaal, D., Verhagen, D.W.M., Wijk, M. van, Bierman, W.F.W., Bakker, M., Kleinnijenhuis, J., Kloeze, E., Stienstra, Y., Wilting, K.R., Wouthuyzen-Bakker, M., Boonstra, A., Meulen, P.A. van der, Weerd, D.A. de, Niesters, H.G.M., Leer-Buter, C.C. van, Knoester, M., Hoepelman, A.I.M., Barth, R.E., Bruns, A.H.W., Ellerbroek, P.M., Mudrikova, T., Oosterheert, J.J., Schadd, E.M., Wassenberg, M.W.M., Zoelen, M.A.D. van, Aarsman, K., Elst-Laurijssen, D.H., Rozemeijer, Graduate School, AII - Infectious diseases, APH - Aging & Later Life, Infectious diseases, Global Health, APH - Digital Health, APH - Personalized Medicine, APH - Global Health, Microbes in Health and Disease (MHD), Neurochirurgie, RS: MHeNs - R3 - Neuroscience, Med Microbiol, Infect Dis & Infect Prev, MUMC+: DA MMI Staf (9), RS: CAPHRI - R4 - Health Inequities and Societal Participation, Internal medicine, Pediatric surgery, Amsterdam Movement Sciences - Rehabilitation & Development, ACS - Diabetes & metabolism, AGEM - Digestive immunity, Medical Microbiology and Infection Prevention, Amsterdam Reproduction & Development (AR&D), Internal Medicine, Virology, and Medical Microbiology & Infectious Diseases

Subjects
Male, Heart disease, Human immunodeficiency virus (HIV), risk prediction algorithms, Blood Pressure, HIV Infections, Disease, 030312 virology, medicine.disease_cause, SUBCLINICAL ATHEROSCLEROSIS, Risk Factors, cardiovascular disease, FRAMINGHAM, Pharmacology (medical), Netherlands, 0303 health sciences, INFECTED PATIENTS, Framingham Risk Score, Middle Aged, Prediction algorithms, Cholesterol, Infectious Diseases, Anti-Retroviral Agents, Cardiovascular Diseases, HUMAN-IMMUNODEFICIENCY-VIRUS, Female, Risk assessment, Algorithms, Adult, Anti-HIV Agents, CARDIOLOGY/AMERICAN HEART ASSOCIATION, HEART-DISEASE, AMERICAN-COLLEGE, DATA-COLLECTION, Risk Assessment, EVENTS, 03 medical and health sciences, SDG 3 - Good Health and Well-being, INFLAMMATION, Environmental health, SCORE, medicine, Humans, Propensity Score, business.industry, HIV, medicine.disease, CD4 Lymphocyte Count, MYOCARDIAL-INFARCTION, Propensity score matching, Disease risk, business
Abstract

Background: People living with HIV (PLWH) experience a higher cardiovascular disease (CVD) risk. Yet, traditional algorithms are often used to estimate CVD risk. We evaluated the performance of 4 commonly used algorithms.Setting: The Netherlands.Methods: We used data from 16,070 PLWH aged > 18 years, who were in care between 2000 and 2016, had no pre-existing CVD, had initiated first combination antiretroviral therapy >1 year ago, and had available data on CD4 count, smoking status, cholesterol, and blood pressure. Predictive performance of 4 algorithms [Data Collection on Adverse Effects of Anti-HIV Drugs Study (D: A: D); Systematic COronary Risk Evaluation adjusted for national data (SCORE-NL); Framingham CVD Risk Score (FRS); and American College of Cardiology and American Heart Association Pooled Cohort Equations (PCE)] was evaluated using a Kaplan-Meier approach. Model discrimination was assessed using Harrell's C-statistic. Calibration was assessed using observed-versusexpected ratios, calibration plots, and Greenwood-Nam-D'Agostino goodness-of-fit tests.Results: All algorithms showed acceptable discrimination (Harrell's C-statistic 0.73-0.79). On a population level, D: A: D, SCORE-NL, and PCE slightly underestimated, whereas FRS slightly overestimated CVD risk (observed-versus-expected ratios 1.35, 1.38, 1.14, and 0.92, respectively). D: A: D, FRS, and PCE best fitted our data but still yielded a statistically significant lack of fit (Greenwood-Nam-D'Agostino chi(2) ranged from 24.57 to 34.22, P Conclusions: All algorithms perform reasonably well in PLWH, with SCORE-NL performing poorest. Prediction algorithms are useful for clinical practice, but clinicians should be aware of their limitations (ie, lack of fit and slight underestimation of CVD risk in low-risk groups).

Published
2019

8. High treatment uptake in human immunodeficiency virus/ hepatitis C virus-coinfected patients after unrestricted access to direct-acting antivirals in the Netherlands

Author

Boerekamps, A. (Anne), Newsum, A.M. (Astrid M.), Smit, C. (Colette), Arends, J.E. (Joop), Richter, C. (Clemens), Reiss, P. (Peter), Rijnders, B.J.A. (Bart), Brinkman, K. (Kees), Valk, M. (Marc) van der, Geerlings, S.E. (Suzanne), Godfried, M.H., Goorhuis, A. (Abraham), Hovius, J.W.R. (Joppe), Meer, J.T.M. (J. T M) van der, Kuijpers, T.W. (Taco W.), Nellen, F.J.B. (F. J B), Van Der Poll, D.T. (D. T.), Prins, J.M. (Jan), Van Vugt, H.J.M. (H. J.M.), Wiersinga, W.J. (W. J.), Wit, F.W.N.M. (Ferdinand), Van Duinen, M. (M.), Van Eden, J., Van Hes, A.M.H., Mutschelknauss, M., Nobel, H.E., Pijnappel, F.J.J., Weijsenfeld, A.M., Jurriaans, S. (Suzanne), Back, N. (Nicole), Zaaijer, H.L. (Hans), Berkhout, B. (Ben), Cornelissen, M. (Marion), Schinkel, C.J., Wolthers, K.C. (Katja), Van Den Berge, M., Stegeman, A., Baas, S., Hage De Looff, L. (L.), Wintermans, B. (B.), Veenemans, J. (J.), Pronk, M.J.H. (Marjolijn), Ammerlaan, H.S.M. (Heidi), De Munnik, E.S., Jansz, A.R. (A. R.), Tjhie, J. (J.), Wegdam, M.C.A., Deiman, B. (B.), Scharnhorst, V., Eeden, A. (Arne) van, Brokking, W. (W.), Groot, M.M. (Marieke), Elsenburg, L.J.M. (L. J.M.), Damen, M. (M.), Kwa, I.S., Kasteren, M.E.E. (Marjo) van, Brouwer, A.E., Van Erve, R. (R.), De Kruijf-Van De Wiel, B.A.F.M. (B. A.F.M.), Keelan-Pfaf, S. (S.), Van Der Ven, B. (B.), Van Der Ven, B., Buiting, A.G.M. (Anton), Kabel, P.J. (P. J.), Versteeg, D., Ende, M.E. (Marchina) van der, Bax, H.I. (Hannelore), Gorp, E.C.M. (Eric) van, Nouwen, J.L. (Jan), Schurink, C.A.M. (Carolina), Verbon, A. (Annelies), Vriessluijs, T.E.M.S. (Theodora) de, De Jong-Peltenburg, N.C. (N. C.), Bassant, N., Van Beek, J.E.A., Vriesde, M., van Zonneveld, L. (Laura), Van Den Berg-Cameron, H.J., Groot, J.C. (Jan Cees) de, De Zeeuw-De Man, M., Boucher, C.A.B. (Charles), Koopmans D.V.M., M.P.G. (Marion), Kampen, J.J.A. (Jeroen) van, Pas, S.D. (Suzan), Branger, J., Rijkeboer-Mes, A. (A.), Duijf-Van De Ven, C.J.H.M., Schippers, E.F. (E. F.), Nieuwkoop, C. (Cees) van, Van IJperen, J.M. (J. M.), Geilings, J. (J.), Van Der Hut, G., Burgel, N.D. (Nathalie ) van, Leyten, E.M.S. (Eliane), Gelinck, L.B.S. (Luc), Van Hartingsveld, A.Y. (A. Y.), Meerkerk, C., Wildenbeest, G.S., Heikens, E. (E.), Groeneveld, P.H.P. (P. H.P.), Bouwhuis, J.W. (Jolande), Lammers, A.J.J. (A. J.J.), Kraan, S. (S.), Van Hulzen, A.G.W., Van Der Bliek, G.L. (G. L.), Bor, P.C.J., Bloembergen, P. (Peter), Wolfhagen, M.J.H.M., Ruijs, G. (G.), Kroon, F.P. (F. P.), Boer, M.G.J. (Mark) de, Scheper, H. (H.), Jolink, A. (Albert), Vollaard, A. (Albert), Dorama, W. (Willemien), Van Holten, N. (N.), Claas, E.C.J. (Eric), Wessels, E. (E.), Hollander, J.G. (Jan) den, Pogány, K. (Katalin), Roukens, A. (A.), Kastelijns, M. (M.), Smit, J.V., Smit, E., Struik-Kalkman, D. (D.), Tearno, C. (C.), Van Niekerk, T., Pontesilli, O. (Oscar), Lowe, S.H. (S. H.), Oude Lashof, A. (A.), Posthouwer, D. (Dirk), Ackens, R.P. (R. P.), Burgers, K. (K.), Schippers, J., Weijenberg-Maes, B. (B.), Loo, I. (Inge) van, Havenith, T., Mulder, J.W. (J. W.), Vrouenraets, B.C. (Bart), Lauw, F.N. (F. N.), van Broekhuizen, M. (Marjolein), Vlasblom, D.J., Smits, P.H.M. (Paul), Weijer, S. (S.), El Moussaoui, R., Bosma, A.S. (A. S.), Vonderen, M.G.A. van, Van Houte, D.P.F., Kampschreur, L.M., Dijkstra, K. (K.), Faber, S., Weel, J. (J.), Kootstra, J.G. (Jille), Delsing, C.E. (C. E.), Van Der Burg-Van De Plas, M. (M.), Heins, H., Lucas, E. (E.), Kortmann, B., Van Twillert, G. (G.), Renckens, R. (Rosemarijn), Ruiter-Pronk, D. (D.), Van Truijen-Oud, F.A., Cohen Stuart, J.W.T. (James), IJzerman, E.P.F. (Ed), Jansen, R.J. (Roel), Rozemeijer, W. (Wouter), Van Der Reijden, W.A. (W. A.), Berk, G.E.L. (Guido) van den, Blok, W.L. (Willem), Frissen, P.H.J., Lettinga, K.D. (Kamilla), Schouten, W.E.M.I. (Ineke), Veenstra, J. (Jan), Brouwer, C.J., Geerders, G.F., Hoeksema, K., Kleene, M.J., Van Der Meché, I.B., Spelbrink, M. (M.), Toonen, A.J.M., Wijnands, S. (S.), Kwa, S.L.S. (Stefan), Regez, R.M. (Rosa), Crevel, R. (Reinout) van, Keuter, M. (Monique), Ven, A.D. (Andre´) van, Ter Hofstede, H.J.M. (H. J.M.), Dofferhoff, A.S.M. (Anton), Hoogerwerf, J. (J.), Grintjes-Huisman, K.J.T., De Haan, M. (M.), Marneef, M. (M.), Hairwassers, A. (A.), Rahamat-Langendoen, J. (J.), Stelma, F.F. (Foekje), Burger, D.M. (David), Gisolf, E.H. (Elisabeth), Hassing, R.J. (Robert), Claassen, M.A.A. (Mark), Ter Beest, G. (G.), Van Bentum, P.H.M., Langebeek, N. (Nienke), Tiemessen, R. (R.), Swanink, C. (Caroline), Lelyveld, S.F.L. van, Soetekouw, R. (Robert), Van Der Prijt, L.M.M., Van Der Swaluw, J. (J.), Bermon, N. (N.), Jansen, R. (R.), Herpers, B.L. (B. L.), Veenendaal, D. (Dick), Verhagen, D.W.M. (Dominique), Van Wijk, M. (M.), Bierman, W.F.W. (Wouter), Bakker, M. (M.), Kleinnijenhuis, J. (J.), Kloeze, E. (E.), Stienstra, Y. (Y.), Wilting, K.R., Wouthuyzen-Bakker, M. (Marjan), Boonstra, P.A. (André), Van Der Meulen, P.A., De Weerd, D.A., Niesters, H.G.M. (Bert), Van Leer-Buter, C. (Coretta), Knoester, M. (M.), Hoepelman, I.M. (Ilja Mohandas), Barth, R.E. (R. E.), Bruns, A.H.W. (A. H.W.), Ellerbroek, P.M. (P.), Mudrikova, T. (Tania Tania), Oosterheert, J.J. (Jan Jelrik), Schadd, E.M. (E. M.), Wassenberg, M.W.M., Van Zoelen, M.A.D. (M. A.D.), Aarsman, K. (K.), Van Elst-Laurijssen, D.H.M. (D. H.M.), De Kroon, I. (I.), Van Rooijen, C.S.A.M. (C. S.A.M.), Van Berkel, M. (M.), Schuurman, R. (Rob), Verduyn-Lunel, F., Wensing, A. (Amj), Peters, E.J.G., Van Agtmael, M.A. (M. A.), Bomers, M., Heitmuller, M. (M.), Laan, L.M., Ang, C.W. (Wim), Houdt, R. van, Pettersson, A. (Annika), Vandenbroucke-Grauls, C.M.J.E. (Christina), Bezemer, D.O. (Daniela), Sighem, A.I. (Ard) van, Smit, C. (Cees), Wit, F. (Ferdinand), Boender, T.S. (T. S.), Zaheri, S. (S.), Hillebregt, M.M.J. (Mariska), De Jong, A., Bergsma, D., Grivell, S., Jansen, A. (A.), Raethke, M., Meijering, R., Rutkens, T. (T.), De Groot, L. (L.), Van Den Akker, M. (M.), Bakker, Y., Bezemer, M. (M.), Claessen, E., El Berkaoui, A. (A.), Geerlinks, J. (J.), Koops, J. (J.), Kruijne, E., Lodewijk, C., Van Der Meer, R. (R.), Munjishvili, L., Paling, F. (F.), Peeck, B., Ree, C., Regtop, R., Ruijs, Y., Schoorl, M. (Marianne), Timmerman, A. (A.), Tuijn, E., Veenenberg, L., Van Der Vliet, S. (S.), Wisse, A. (A.), De Witte, E.C. (E. C.), Woudstra, T., Tuk, B. (B.), Boerekamps, A. (Anne), Newsum, A.M. (Astrid M.), Smit, C. (Colette), Arends, J.E. (Joop), Richter, C. (Clemens), Reiss, P. (Peter), Rijnders, B.J.A. (Bart), Brinkman, K. (Kees), Valk, M. (Marc) van der, Geerlings, S.E. (Suzanne), Godfried, M.H., Goorhuis, A. (Abraham), Hovius, J.W.R. (Joppe), Meer, J.T.M. (J. T M) van der, Kuijpers, T.W. (Taco W.), Nellen, F.J.B. (F. J B), Van Der Poll, D.T. (D. T.), Prins, J.M. (Jan), Van Vugt, H.J.M. (H. J.M.), Wiersinga, W.J. (W. J.), Wit, F.W.N.M. (Ferdinand), Van Duinen, M. (M.), Van Eden, J., Van Hes, A.M.H., Mutschelknauss, M., Nobel, H.E., Pijnappel, F.J.J., Weijsenfeld, A.M., Jurriaans, S. (Suzanne), Back, N. (Nicole), Zaaijer, H.L. (Hans), Berkhout, B. (Ben), Cornelissen, M. (Marion), Schinkel, C.J., Wolthers, K.C. (Katja), Van Den Berge, M., Stegeman, A., Baas, S., Hage De Looff, L. (L.), Wintermans, B. (B.), Veenemans, J. (J.), Pronk, M.J.H. (Marjolijn), Ammerlaan, H.S.M. (Heidi), De Munnik, E.S., Jansz, A.R. (A. R.), Tjhie, J. (J.), Wegdam, M.C.A., Deiman, B. (B.), Scharnhorst, V., Eeden, A. (Arne) van, Brokking, W. (W.), Groot, M.M. (Marieke), Elsenburg, L.J.M. (L. J.M.), Damen, M. (M.), Kwa, I.S., Kasteren, M.E.E. (Marjo) van, Brouwer, A.E., Van Erve, R. (R.), De Kruijf-Van De Wiel, B.A.F.M. (B. A.F.M.), Keelan-Pfaf, S. (S.), Van Der Ven, B. (B.), Van Der Ven, B., Buiting, A.G.M. (Anton), Kabel, P.J. (P. J.), Versteeg, D., Ende, M.E. (Marchina) van der, Bax, H.I. (Hannelore), Gorp, E.C.M. (Eric) van, Nouwen, J.L. (Jan), Schurink, C.A.M. (Carolina), Verbon, A. (Annelies), Vriessluijs, T.E.M.S. (Theodora) de, De Jong-Peltenburg, N.C. (N. C.), Bassant, N., Van Beek, J.E.A., Vriesde, M., van Zonneveld, L. (Laura), Van Den Berg-Cameron, H.J., Groot, J.C. (Jan Cees) de, De Zeeuw-De Man, M., Boucher, C.A.B. (Charles), Koopmans D.V.M., M.P.G. (Marion), Kampen, J.J.A. (Jeroen) van, Pas, S.D. (Suzan), Branger, J., Rijkeboer-Mes, A. (A.), Duijf-Van De Ven, C.J.H.M., Schippers, E.F. (E. F.), Nieuwkoop, C. (Cees) van, Van IJperen, J.M. (J. M.), Geilings, J. (J.), Van Der Hut, G., Burgel, N.D. (Nathalie ) van, Leyten, E.M.S. (Eliane), Gelinck, L.B.S. (Luc), Van Hartingsveld, A.Y. (A. Y.), Meerkerk, C., Wildenbeest, G.S., Heikens, E. (E.), Groeneveld, P.H.P. (P. H.P.), Bouwhuis, J.W. (Jolande), Lammers, A.J.J. (A. J.J.), Kraan, S. (S.), Van Hulzen, A.G.W., Van Der Bliek, G.L. (G. L.), Bor, P.C.J., Bloembergen, P. (Peter), Wolfhagen, M.J.H.M., Ruijs, G. (G.), Kroon, F.P. (F. P.), Boer, M.G.J. (Mark) de, Scheper, H. (H.), Jolink, A. (Albert), Vollaard, A. (Albert), Dorama, W. (Willemien), Van Holten, N. (N.), Claas, E.C.J. (Eric), Wessels, E. (E.), Hollander, J.G. (Jan) den, Pogány, K. (Katalin), Roukens, A. (A.), Kastelijns, M. (M.), Smit, J.V., Smit, E., Struik-Kalkman, D. (D.), Tearno, C. (C.), Van Niekerk, T., Pontesilli, O. (Oscar), Lowe, S.H. (S. H.), Oude Lashof, A. (A.), Posthouwer, D. (Dirk), Ackens, R.P. (R. P.), Burgers, K. (K.), Schippers, J., Weijenberg-Maes, B. (B.), Loo, I. (Inge) van, Havenith, T., Mulder, J.W. (J. W.), Vrouenraets, B.C. (Bart), Lauw, F.N. (F. N.), van Broekhuizen, M. (Marjolein), Vlasblom, D.J., Smits, P.H.M. (Paul), Weijer, S. (S.), El Moussaoui, R., Bosma, A.S. (A. S.), Vonderen, M.G.A. van, Van Houte, D.P.F., Kampschreur, L.M., Dijkstra, K. (K.), Faber, S., Weel, J. (J.), Kootstra, J.G. (Jille), Delsing, C.E. (C. E.), Van Der Burg-Van De Plas, M. (M.), Heins, H., Lucas, E. (E.), Kortmann, B., Van Twillert, G. (G.), Renckens, R. (Rosemarijn), Ruiter-Pronk, D. 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Abstract

Background The Netherlands has provided unrestricted access to direct-acting antivirals (DAAs) since November 2015. We analyzed the nationwide hepatitis C virus (HCV) treatment uptake among patients coinfected with human immunodeficiency virus (HIV) and HCV. Methods Data were obtained from the ATHENA HIV observational cohort in which >98% of HIV-infected patients ever registered since 1998 are included. Patients were included if they ever had 1 positive HCV RNA result, did not have spontaneous clearance, and were known to still be in care. Treatment uptake and outcome were assessed. When patients were treated more than once, data were included from only the most recent treatment episode. Data were updated until February 2017. In addition, each treatment center was queried in April 2017 for a data update on DAA treatment and achieved sustained virological response. Results Of 23574 HIV-infected patients ever linked to care, 1471 HCV-coinfected patients (69% men who have sex with men, 15% persons who [formerly] injected drugs, and 15% with another HIV transmission route) fulfilled the inclusion criteria. Of these, 87% (1284 of 1471) had ever initiated HCV treatment between 2000 and 2017, 76% (1124 of 1471) had their HCV infection cured; DAA treatment results were pending in 6% (92 of 1471). Among men who have sex with men, 83% (844 of 1022) had their HCV infection cured, and DAA treatment results were pending in 6% (66 of 1022). Overall, 187 patients had never initiated treatment, DAAs had failed in 14, and a pegylated interferon-alfa–based regimen had failed in 54. Conclusions Fifteen months after unrestricted DAA availability the majority of HIV/HCV-coinfected patients in the Netherlands have their HCV infection cured (76%) or are awaiting DAA treatment results (6%). This rapid treatment scale-up may contribute to future HCV elimination among these patients.

Published
2018
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9. Opportunistic infections and AIDS malignancies early after initiating combination antiretroviral therapy in high-income countries

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Lodi, S. Del Amo, J. Moreno, S. Bucher, H.C. Furrer, H. Logan, R. Sterne, J. Pérez-Hoyos, S. Jarrín, I. Phillips, A. Olson, A. Van Sighem, A. Reiss, P. Sabin, C. Jose, S. Justice, A. Goulet, J. Miró, J.M. Ferrer, E. Meyer, L. Seng, R. Vourli, G. Antoniadou, A. Dabis, F. Vandenhede, M.-A. Costagliola, D. Abgrall, S. Hernán, M.A. Hernan, M. Bansi, L. Hill, T. Sabin, C. Dunn, D. Porter, K. Glabay, A. Orkin, C. Thomas, R. Jones, K. Fisher, M. Perry, N. Pullin, A. Churchill, D. Gazzard, B. Nelson, M. Asboe, D. Bulbeck, S. Mandalia, S. Clarke, J. Delpech, V. Anderson, J. Munshi, S. Post, F. Easterbrook, P. Khan, Y. Patel, P. Karim, F. Duffell, S. Gilson, R. Man, S.-L. Williams, I. Gompels, M. Dooley, D. Schwenk, A. Ainsworth, J. Johnson, M. Youle, M. Lampe, F. Smith, C. Grabowska, H. Chaloner, C. Ismajani Puradiredja, D. Bansi, L. Hill, T. Phillips, A. Sabin, C. Walsh, J. Weber, J. Kemble, C. Mackie, N. Winston, A. Leen, C. Wilson, A. Bezemer, D.O. Gras, L.A.J. Kesselring, A.M. 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Saada, M. Medus, M. Guillevin, L. Salmon, D. Tahi, T. Yazdanpanah, Y. Pavel, S. Marien, M.C. Drenou, B. Beck-Wirth, G. Beck, C. Benomar, M. Katlama, C. Tubiana, R. Ait Mohand, H. Chermak, A. Ben Abdallah, S. Bentata, M. Touam, F. Hoen, B. Drobacheff, C. Folzer, A. Massip, P. Obadia, M. Prudhomme, L. Bonnet, E. Balzarin, F. Pichard, E. Chennebault, J.M. Fialaire, P. Loison, J. Galanaud, P. Boué, F. Bornarel, D. Verdon, R. Bazin, C. Six, M. Ferret, P. Weiss, L. Batisse, D. Gonzales-Canali, G. Tisne-Dessus, D. Devidas, A. Chevojon, P. Turpault, I. Lafeuillade, A. Cheret, A. Philip, G. Morel, P. Timsit, J. Herson, S. Amirat, N. Simon, A. Brancion, C. Cabane, J. Picard, O. Tredup, J. Stein, A. Ravault, I. Chavanet, C. Buisson, M. Treuvetot, S. Choutet, P. Nau, P. Bastides, F. May, T. Boyer, L. Wassoumbou, S. Oksenhendeler, E. Gérard, L. Bernard, L. De Truchis, P. Berthé, H. Domart, Y. Merrien, D. Greder Belan, A. Gayraud, M. Bodard, L. Meudec, A. Beuscart, C. Daniel, C. Pape, E. Vinceneux, P. Simonpoli, A.M. Zeng, A. Fournier, L. Fuzibet, J.G. Sohn, C. Rosenthal, E. Quaranta, M. Dellamonica, P. Chaillou, S. Sabah, M. Audhuy, B. Schieber, A. Moreau, P. Niault, M. Vaillant, O. Huchon, G. Compagnucci, A. De Lacroix Szmania, I. Richier, L. Lamaury, I. Saint-Dizier, F. Garipuy, D. Gastaut, J.A. Drogoul, M.P. Poizot Martin, I. Fabre, G. Lambert De Cursay, G. Abraham, B. Perino, C. Lagarde, P. David, F. Roche-Sicot, J. Saraux, J.L. Leprêtre, A. Fampin, B. Uludag, A. Morin, A.S. Bletry, O. Zucman, D. Regnier, A. Girard, J.J. Quinsat, D.T. Heripret, L. Grihon, F. Houlbert, D. Ruel, M. Chemlal, K. Caron, F. Debab, Y. Tremollieres, F. Perronne, V. Lepeu, G. Slama, B. Perré, P. Miodovski, C. Guermonprez, G. Dulioust, A. Boudon, P. Malbec, D. Patey, O. Semaille, C. Deville, J. Remy, G. Béguinot, I. Galanaud, P. Boue, F. Chambrin, V. Pignon, C. Estocq, G.A. Levy, A. Delfraissy, J.F. Goujard, C. Duracinsky, M. Le Bras, P. Ngussan, M.S. Peretti, D. Medintzeff, N. Lambert, T. Segeral, O. Lezeau, P. Laurian, Y. Weiss, L. Buisson, M. Piketty, C. Karmochkine, M. Batisse, D. Eliaszewitch, M. Jayle, D. Tisne-Dessus, D. Kazatchkine, M. Leport, C. Colasante, U. Jadand, C. Jestin, C. Duval, X. Nouaouia, W. Boucherit, S. Vilde, J.L. Girard, P.M. Bollens, D. Binet, D. Diallo, B. Meyohas, M.C. Fonquernie, L. Lagneau, J.L. Salmon, D. Guillevin, L. Tahi, T. Launay, O. Pietrie, M.P. Sicard, D. Stieltjes, N. Michot, J. Sobel, A. Levy, Y. Bourdillon, F. Lascaux, A.S. Lelievre, J.D. Dumont, C. Dupont, B. Obenga, G. Viard, J.P. Maignan, A. Vittecoq, D. Escaut, L. Bolliot, C. Bricaire, F. Katlama, C. Schneider, L. Herson, S. Simon, A. Iguertsira, M. Stein, A. Tomei, C. Ravaux, I. Dhiver, C. Tissot Dupont, H. Vallon, A. Gallais, J. Gallais, H. Gastaut, J.A. Drogoul, M.P. Fabre, G. Dellamonica, P. Durant, J. Mondain, V. Perbost, I. Cassuto, J.P. Karsenti, J.M. Venti, H. Fuzibet, J.G. Rosenthal, E. Ceppi, C. Quaranta, M. Krivitsky, J.A. Bentata, M. Bouchaud, O. Honore, P. Sereni, D. Lascoux, C. Delgado, J. Rouzioux, C. Burgard, M. Boufassa, L. Peynet, J. Pérez-Hoyos, S. Del Amo, J. Alvarez, D. Monge, S. Muga, R. Sanvisens, A. Clotet, B. Tor, J. Bolao, F. Rivas, I. Vallecillo, G. Del Romero, J. Raposo, P. Rodríguez, C. Vera, M. Hurtado, I. Belda, J. Fernandez, E. Alastrue, I. Santos, C. Tasa, T. Juan, A. Trullen, J. Garcia De Olalla, P. Cayla, J. Masdeu, E. Knobel, H. Mirò, J.M. Sambeat, M.A. Guerrero, R. Rivera, E. Guerrero, R. Marco, A. Quintana, M. Gonzalez, C. Castilla, J. Guevara, M. De Mendoza, C. Zahonero, N. Ortíz, M. Paraskevis, D. Touloumi, G. Pantazis, N. Bakoyannis, G. Gioukari, V. Antoniadou, A. Papadopoulos, A. Petrikkos, G. Daikos, G. Psichogiou, M. Gargalianos-Kakolyris, P. Xylomenos, G. Katsarou, O. Kouramba, A. Ioannidou, P. Kordossis, T. Kontos, A. Lazanas, M. Chini, M. Tsogas, N. Panos, G. Paparizos, V. Leuow, K. Kourkounti, S. Sambatakou, H. Mariolis, I. Skoutelis, A. Papastamopoulos, V. Baraboutis, I. The HIV-CAUSAL Collaboration

Subjects
virus diseases
Abstract

Background: There is little information on the incidence of AIDS-defining events which have been reported in the literature to be associated with immune reconstitution inflammatory syndrome (IRIS) after combined antiretroviral therapy (cART) initiation. These events include tuberculosis, mycobacterium avium complex (MAC), cytomegalovirus (CMV) retinitis, progressive multifocal leukoencephalopathy (PML), herpes simplex virus (HSV), Kaposi sarcoma, non-Hodgkin lymphoma (NHL), cryptococcosis and candidiasis. Methods: We identified individuals in the HIV-CAUSAL Collaboration, which includes data from six European countries and the US, who were HIV-positive between 1996 and 2013, antiretroviral therapy naive, aged at least 18 years, hadCD4+ cell count and HIV-RNA measurements and had been AIDS-free for at least 1 month between those measurements and the start of follow-up. For each AIDS-defining event, we estimated the hazard ratio for no cART versus less than 3 and at least 3 months since cART initiation, adjusting for time-varying CD4+ cell count and HIV-RNA via inverse probability weighting. Results: Out of 96 562 eligible individuals (78% men) with median (interquantile range) follow-up of 31 [13,65] months, 55 144 initiated cART. The number of cases varied between 898 for tuberculosis and 113 for PML. Compared with non-cART initiation, the hazard ratio (95% confidence intervals) up to 3 months after cART initiation were 1.21 (0.90-1.63) for tuberculosis, 2.61 (1.05-6.49) for MAC, 1.17 (0.34-4.08) for CMV retinitis, 1.18 (0.62-2.26) for PML, 1.21 (0.83-1.75) for HSV, 1.18 (0.87-1.58) for Kaposi sarcoma, 1.56 (0.82-2.95) for NHL, 1.11 (0.56-2.18) for cryptococcosis and 0.77 (0.40-1.49) for candidiasis. Conclusion: With the potential exception of mycobacterial infections, unmasking IRIS does not appear to be a common complication of cART initiation in high-income countries. © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Published
2014

10. Costs and effects of MRSA control in Dutch hospitals

Author

Wassenberg, M.W.M., Bonten, Marc, Kluijtmans, Jan, and University Utrecht

Subjects
biochemical phenomena, metabolism, and nutrition, bacterial infections and mycoses
Abstract

In the Netherlands the prevalence of MRSA among S. aureus bloodstream isolates was as low as 0.7% in 2008. This low prevalence is maintained by a nationwide MRSA policy (also called search and destroy), that has been employed in Dutch hospitals since 1984. In the last years we have witnessed major changes in the Dutch MRSA epidemiology. Since 2003 a new MRSA strain (ST398), which originated from livestock, emerged in the Netherlands. Importantly, there is now a substantial number of MRSA carriers in the Netherlands with persistent (professional) exposure to ST398 MRSA in whom MRSA eradication will not be effective, due to repeated exposure. We performed a large Dutch multicenter study and calculated that the relative risk on transmission of MRSA ST398 in the hospital, as compared to healthcare associated (HA)-MRSA, was only 0.28. The calculated RA ratio between HA-MRSA and livestock associated MRSA was 5.9 (95% CI 2.2-23.8), suggesting livestock associated MRSA is almost six times less transmissible than HA-MRSA. Also, the MRSA prevalence among admitted patients suspected for MRSA carriage because of treatment in foreign hospitals appeared lower than previously reported: 1.6% and 1.9% in two Dutch multicenter trial we executed between 2005 and 2008. Besides changes in MRSA epidemiology, new rapid diagnostic tests (RDT) have become available that allow more rapid detection for MRSA carriage. The most important advantage of RDT is the reduction in unnecessary pre-emptive isolation days. RDT of MRSA reduced the number of pre-emptive isolation days with 48% and 60% when using chromogenic agar and MRSA PCR, respectively. Infection control policies to prevent S. aureus infections, both MSSA and MRSA, in the Netherlands are cost-saving, despite the costs to execute preventive control policies. Yet, cost-effectiveness of RDT for MRSA is unknown. In the Dutch multicenter trial the extra costs of screening and pre-emptive isolation of high risk patients were €95.77, €125.43 and €6.74 per isolation day avoided, using IDI PCR, GeneXpert PCR and chromogenic agar for MRSA screening, respectively. Since the additional costs of one extra isolation day on a regular ward in a non-outbreak situation were estimated to be €26.34, chromogenic screening, but not PCR-based screening, is a cost saving procedure. In conclusion, there is no need to pre-emptively isolate patients with a high risk for MRSA carriage on hospital admission. These patients can be screened using both RDT and conventional microbiological cultures. Closure of wards for new admissions is rarely necessary anymore when using PCR-based testing.

Published
2010

11. Quantifying Cost-Effectiveness of Controlling Nosocomial Spread of Antibiotic-Resistant Bacteria: The Case of MRSA

Author

Wassenberg, M.W.M., de Wit, G.A., van Hout, B.A., and Bonten, M.J.M.

Subjects
health care economics and organizations
Abstract

Background\ud \ud The costs and benefits of controlling nosocomial spread of antibiotic-resistant bacteria are unknown.\ud \ud Methods\ud \ud We developed a mathematical algorithm to determine cost-effectiveness of infection control programs and explored the dynamical interactions between different epidemiological variables and cost-effectiveness. The algorithm includes occurrence of nosocomial infections, attributable mortality, costs and efficacy of infection control and how antibiotic-resistant bacteria affect total number of infections: do infections with antibiotic-resistant bacteria replace infections caused by susceptible bacteria (replacement scenario) or occur in addition to them (addition scenario). Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia was used for illustration using observational data on S. aureus bacteremia (SAB) in our hospital (n = 189 between 2001–2004, all being methicillin-susceptible S. aureus [MSSA]).\ud \ud Results\ud \ud In the replacement scenario, the costs per life year gained range from € 45,912 to € 6590 for attributable mortality rates ranging from 10% to 50%. Using € 20,000 per life year gained as a threshold, completely preventing MRSA would be cost-effective in the replacement scenario if attributable mortality of MRSA is ≥21%. In the addition scenario, infection control would be cost saving along the entire range of estimates for attributable mortality.\ud \ud Conclusions\ud \ud Cost-effectiveness of controlling antibiotic-resistant bacteria is highly sensitive to the interaction between infections caused by resistant and susceptible bacteria (addition or replacement) and attributable mortality. In our setting, controlling MRSA would be cost saving for the addition scenario but would not be cost-effective in the replacement scenario if attributable mortality would be

Published
2010

12. The nosocomial transmission rate of animal-associated ST398 meticillin-resistant Staphylococcus aureus

Author

Bootsma, M.C.J., Wassenberg, M.W.M., Trapman, J.P., Bonten, M.J.M., Analysis, Stochastics, and Sub Analysis begr. 01-01-2014

Subjects
biochemical phenomena, metabolism, and nutrition, bacterial infections and mycoses
Abstract

The global epidemiology of meticillin-resistant Staphylococcus aureus (MRSA) is characterized by different clonal lineages with different epidemiological behaviour. There are pandemic hospital clones (hospital-associated (HA-)MRSA), clones mainly causing community-acquired infections (community-associated (CA-)MRSA, mainly USA300) and an animal-associated clone (ST398) emerging in European and American livestock with subsequent spread to humans. Nosocomial transmission capacities (RA) of these different MRSA types have never been quantified. Using two large datasets from MRSA outbreaks in Dutch hospitals (dataset 1, the UMC Utrecht for 144 months; dataset 2, 51 hospitals for six months) and a recently developed mathematical model, we determined the genotype-specific RA for ST398 and non-ST398 isolates (categorized as HA-MRSA), using observational data, the detection rate of MRSA carriage and the discharge rate from hospital as the input. After detection of 42 MRSA index cases in dataset 1 (all non-ST398 MRSA) 5076 people were screened, yielding 30 secondary cases. In dataset 2, 75 index cases (51 non-ST398 MRSA and 24 ST398) resulted in 7892 screened individuals and 56 and three secondary cases for non-ST398 MRSA and ST398, respectively. The ratio between discharge and the detection rate was 2.7. RA values (95% confidence interval (CI)) were 0.68 (0.47–0.95) for non-ST398 MRSA in dataset 1, 0.93 (0.71–1.21) for non-ST398 MRSA in dataset 2 and 0.16 (0.04–0.40) for ST398. The RA ratio between non-ST398 MRSA and ST398 was 5.90 (95% CI 2.24–23.81). ST398 is 5.9 times less transmissible than non-ST398 MRSA in Dutch hospitals, which may allow less stringent transmission-control measures for ST398 MRSA

Published
2010

16. Costs and effects of MRSA control in Dutch hospitals

Author

Child Health, Infection & Immunity, MMB, Bonten, Marc, Kluijtmans, Jan, Wassenberg, M.W.M., Child Health, Infection & Immunity, MMB, Bonten, Marc, Kluijtmans, Jan, and Wassenberg, M.W.M.

Published
2010

19. Risk for non-AIDS-defining and AIDS-defining cancer of early versus delayed initiation of antiretroviral therapy

Author

Chammartin, F., Lodi, S., Logan, R., Ryom, L., Mocroft, A., Kirk, O., D'Arminio Monforte, A., Reiss, P., Phillips, A., El-Sadr, W., Hatleberg, C. I., Pradier, C., Bonnet, F., Law, M., De Wit, S., Sabin, C., Lundgren, J. D., Bucher, H. C., Calvo, G., Dabis, F., Morfeldt, L., Weber, R., Lind-Thomsen, A., Salbol Brandt, R., Hillebreght, M., Zaheri, S., Wit, F. W. N. M., Scherrer, A., Schoni-Affolter, F., Rickenbach, M., Tavelli, A., Fanti, I., Leleux, O., Mourali, J., Le Marec, F., Boerg, E., Thulin, E., Sundstrom, A., Bartsch, G., Thompsen, G., Necsoi, C., Delforge, M., Fontas, E., Caissotti, C., Dollet, K., Mateu, S., Torres, F., Petoumenos, K., Blance, A., Huang, R., Puhr, R., Gronborg Laut, K., Kristensen, D., Kamara, D. A., Smith, C. J., Raben, D., Matthews, C., Bojesen, A., Grevsen, A. L., Powderly, B., Shortman, N., Moecklinghoff, C., Reilly, G., Smit, C., Ross, M., Fux, C. A., Morlat, P., Friis-Moller, N., Kowalska, J., Bohlius, J., Bower, M., Fatkenheuer, G., Grulich, A., Sjol, A., Meidahl, P., Iversen, J. S., Hillebregt, M., Prins, J. M., Kuijpers, T. W., Scherpbier, H. J., Van Der Meer, J. T. M., Godfried, M. H., Van Der Poll, T., Nellen, F. J. B., Geerlings, S. E., Van Vugt, M., Pajkrt, D., Bos, J. C., Wiersinga, W. J., Van Der Valk, M., Goorhuis, A., Hovius, J. W., Van Eden, J., Henderiks, A., Van Hes, A. M. H., Mutschelknauss, M., Nobel, H. E., Pijnappel, F. J. J., Jurriaans, S., Back, N. K. T., Zaaijer, H. L., Berkhout, B., Cornelissen, M. T. E., Schinkel, C. J., Thomas, X. V., Van Den Berge, M., Stegeman, A., Baas, S., Hage De Looff, L., Versteeg, D., Pronk, M. J. H., Ammerlaan, H. S. M., de Munnik, E. S., Jansz, A. R., Tjhie, J., Wegdam, M. C. A., Deiman, B., Scharnhorst, V., Van Der Plas, A., Weijsenfeld, A. M., Van Der Ende, M. E., de Vries-Sluijs, T. E. M. S., van Gorp, E. C. M., Schurink, C. A. M., Nouwen, J. L., Verbon, A., Rijnders, B. J. A., Bax, H. I., Van Der Feltz, M., Bassant, N., Van Beek, J. E. A., Vriesde, M., Van Zonneveld, L. M., De Oude-Lubbers, A., Van Den Berg-Cameron, H. J., Bruinsma-Broekman, F. B., de Groot, J., De Zeeuw-De Man, M., Boucher, C. A. B., Koopmans, M. P. G., van Kampen, J. J. A., Pas, S. D., Driessen, G. J. A., van Rossum, A. M. C., Van Der Knaap, L. C., Visser, E., Branger, J., Rijkeboer-Mes, A., Duijf-Van De Ven, C. J. H. M., Schippers, E. F., van Nieuwkoop, C., van IJperen, J. M., Geilings, J., van der Hut, G., Franck, P. F. H., Van Eeden, A., Brokking, W., Groot, M., Elsenburg, L. J. M., Damen, M., Kwa, I. S., Groeneveld, P. H. P., Bouwhuis, J. W., Van Den Berg, J. F., Van Hulzen, A. G. W., Van Der Bliek, G. L., Bor, P. C. J., Bloembergen, P., Wolfhagen, M. J. H. M., Ruijs, G. J. H. M., Kroon, F. P., De Boer, M. G. J., Bauer, M. P., Jolink, H., Vollaard, A. M., Dorama, W., Van Holten, N., Claas, E. C. J., Wessels, E., Den Hollander, J. G., Pogany, K., Roukens, A., Kastelijns, M., Smit, J. V., Smit, E., Struik-Kalkman, D., Tearno, C., Bezemer, M., van Niekerk, T., Pontesilli, O., Lowe, S. H., Oude Lashof, A. M. L., Posthouwer, D., Ackens, R. P., Schippers, J., Vergoossen, R., Weijenberg-Maes, B., van Loo, I. H. M., Havenith, T. R. A., Leyten, E. M. S., Gelinck, L. B. S., van Hartingsveld, A., Meerkerk, C., Wildenbeest, G. S., Mutsaers, J. A. E. M., Jansen, C. L., Mulder, J. W., Vrouenraets, S. M. E., Lauw, F. N., van Broekhuizen, M. C., Paap, H., Vlasblom, D. J., Smits, P. H. M., Weijer, S., El Moussaoui, R., Bosma, A. S., van Vonderen, M. G. A., van Houte, D. P. F., Kampschreur, L. M., Dijkstra, K., Faber, S., Weel, J., Kootstra, G. J., Delsing, C. E., van der Burg-Van de Plas, M., Heins, H., Lucas, E., Kortmann, W., van Twillert, G., Cohen Stuart, J. W. T., Diederen, B. M. W., van Truijen-Oud, F. A., van der Reijden, W. A., Jansen, R., Brinkman, K., van den Berk, G. E. L., Blok, W. L., Frissen, P. H. J., Lettinga, K. D., Schouten, W. E. M., Veenstra, J., Brouwer, J. C., Geerders, F. G., Hoeksema, K., Kleene, J. M., van der Meche, B. I., Spelbrink, M., Sulman, H., Toonen, A. J. M., Wijnands, S., Kwa, D., Witte, E., Koopmans, P. P., Keuter, M., van der Ven, A. J. A. M., ter Hofstede, H. J. M., Dofferhoff, A. S. M., van Crevel, R., Albers, M., Bosch, M. E. W., Grintjes-Huisman, K. J. T., Zomer, J. B., Stelma, F. F., Rahamat-Langendoen, J., Burger, D., Richter, C., Gisolf, H. E., Hassing, J. R., ter Beest, G., van Bentum, P. H. M., Langebeek, N., Tiemessen, R., Swanink, C. M. A., van Lelyveld, S. F. L., Soetekouw, R., Hulshoff, N., van der Prijt, L. M. M., van der Swaluw, J., Bermon, N., Herpers, B. L., Veenendaal, D., Verhagen, W. D. M., van Wijk, M., van Kasteren, M. E. E., Brouwer, E. A., de Kruijf-Van de Wiel, B. A. F. M., Kuipers, M., Santegoets, R. M. W. J., van der Ven, B., Marcelis, H. J., Buiting, A. G. M., Kabel, J. P., Bierman, W. F. W., Scholvinck, H., Wilting, R. K., Stienstra, Y., de Groot-De Jonge, H., van der Meulen, A. P., de Weerd, A. D., Ludwig-Roukema, J., Niesters, H. G. M., Riezebos-Brilman, A., van Leer-Buter, C. C., Knoester, M., Hoepelman, A. I. M., Mudrikova, T., Ellerbroek, M. P., Oosterheert, J. J., Arends, E. J., Barth, E. R., Wassenberg, M. W. M., Schadd, M. E., van Elst-Laurijssen, D. H. M., van Oers-Hazelzet, B. E., Vervoort, S., van Berkel, M., Schuurman, R., Verduyn-Lunel, F., Wensing, A. M. J., Peters, E. J. G., van Agtmael, A. M., Bomers, M., de Vocht, J., Heitmuller, M., Laan, M. L., Pettersson, M. A., Vandenbroucke-Grauls, C. M. J. E., Ang, W. C., Geelen, S. P. M., Wolfs, T. F. W., Bont, J. L., Nauta, N., Bezemer, O. D., van Sighem, I. A., Boender, S. T., de Jong, A., Bergsma, D., Hoekstra, P., de Lang, A., Grivell, S., Jansen, A., Rademaker, J. M., Raethke, M., Meijering, R., Schnorr, 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., Mercie, P., Neau, D., Pellegrin, L. J., Tchamgoue, S., Lazaro, E., Cazanave, C., Vandenhende, M., Vareil, O. M., Gerard, Y., Blanco, P., Bouchet, S., Breilh, D., Fleury, H., Pellegrin, I., Chene, G., Thiebaut, R., Wittkop, L., Lawson-Ayayi, S., Gimbert, A., Desjardin, S., Lacaze-Buzy, L., Petrov-Sanchez, V., Andre, N., Bernard, K., Caubet, O., Caunegre, L., Chossat, I., Courtault, C., Dauchy, A. 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P., Kuznetsova A., Kyselyova G., Sluzhynska M., Johnson A.M., Simons E., Orkin C., Weber J., Scullard G., Clarke A., Leen C., Thulin G., Akerlund B., Koppel K., Karlsson A., Hakangard C., Castelli F., Cauda R., Di Perri G., Iardino R., Ippolito G., Marchetti C.G., Perno F.C., 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 R.M., Cingolani A., Cinque P., De Luca A., Di Biagio A., Gori A., Guaraldi G., Lapadula G., Madeddu G., Maggiolo F., Marcotullio S., Monno L., Nozza S., Quiros Roldan E., Rossotti R., Rusconi S., Santoro M.M., 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 E.P., 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 C.M., Piolini R., Ridolfo L.A., Salpietro S., Tincati C., Puzzolante C., Abrescia N., Chirianni A., Borgia G., Orlando R., Bonadies G., Di Martino F., Gentile I., Maddaloni L., Cattelan M.A., Marinello S., Cascio A., Colomba C., Baldelli F., Schiaroli E., Parruti G., Sozio F., Magnani G., Ursitti A.M., Cristaudo A., Baldin G., Capozzi M., Cicalini S., Fontanelli Sulekova L., Iaiani G., Latini A., Mastrorosa I., 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 C.G., Sciandra M., Bassetti M., Londero A., Pellizzer G., Manfrin V., Starnini G., Ialungo A., 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 M.P., Aubert V., Bernasconi E., Ciuffi A., Dollenmaier G., Egger M., Elzi L., Fehr J., Fellay J., Gunthard F.H., Haerry D., Hasse B., Hirsch H.H., Hoffmann M., Hosli I., Kahlert C., Kaiser L., Keiser O., Klimkait T., Kouyos D.R., Kovari H., Ledergerber B., Martinetti G., Martinez de Tejada B., Marzolini C., Metzner J.K., Muller N., Nicca D., Pantaleo G., Paioni P., Rauch A., Rudin C., Speck R., Stockle M., Tarr P., Trkola A., Vernazza P., Wandeler G., Yerly S., 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), Internal Medicine, Medical Microbiology & Infectious Diseases, Virology, Pediatric Surgery, Pediatrics, Chammartin, F, Lodi, S, Logan, R, Ryom, L, Mocroft, A, Kirk, O, D'Arminio Monforte, A, Reiss, P, Phillips, A, El-Sadr, W, Hatleberg, C, Pradier, C, Bonnet, F, Law, M, De Wit, S, Sabin, C, Lundgren, J, Bucher, H, Calvo, G, Dabis, F, Morfeldt, L, Weber, R, Lind-Thomsen, A, Salbol Brandt, R, Hillebreght, M, Zaheri, S, Wit, F, Scherrer, A, Schoni-Affolter, F, Rickenbach, M, Tavelli, A, Fanti, I, Leleux, O, Mourali, J, Le Marec, F, Boerg, E, Thulin, E, Sundstrom, A, Bartsch, G, Thompsen, G, Necsoi, C, Delforge, M, Fontas, E, Caissotti, C, Dollet, K, Mateu, S, Torres, F, Petoumenos, K, Blance, A, Huang, R, Puhr, R, Gronborg Laut, K, Kristensen, D, Kamara, D, Smith, C, Raben, D, Matthews, C, Bojesen, A, Grevsen, A, Powderly, B, Shortman, N, Moecklinghoff, C, Reilly, G, Smit, C, Ross, M, Fux, C, Morlat, P, Friis-Moller, N, Kowalska, J, Bohlius, J, Bower, M, Fatkenheuer, G, Grulich, A, Sjol, A, Meidahl, P, Iversen, J, Hillebregt, M, Prins, J, Kuijpers, T, Scherpbier, H, Van Der Meer, J, Godfried, M, Van Der Poll, T, Nellen, F, Geerlings, S, Van Vugt, M, Pajkrt, D, Bos, J, Wiersinga, W, Van Der Valk, M, Goorhuis, A, Hovius, J, Van Eden, J, Henderiks, A, Van Hes, A, Mutschelknauss, M, Nobel, H, Pijnappel, F, Jurriaans, S, Back, N, Zaaijer, H, Berkhout, B, Cornelissen, M, Schinkel, C, Thomas, X, Van Den Berge, M, Stegeman, A, Baas, S, Hage De Looff, L, Versteeg, D, Pronk, M, Ammerlaan, H, de Munnik, E, Jansz, A, Tjhie, J, Wegdam, M, Deiman, B, Scharnhorst, V, Van Der Plas, A, Weijsenfeld, A, Van Der Ende, M, de Vries-Sluijs, T, van Gorp, E, Schurink, C, Nouwen, J, Verbon, A, Rijnders, B, Bax, H, Van Der Feltz, M, Bassant, N, Van Beek, J, Vriesde, M, Van Zonneveld, L, De Oude-Lubbers, A, Van Den Berg-Cameron, H, Bruinsma-Broekman, F, de Groot, J, De Zeeuw-De Man, M, Boucher, C, Koopmans, M, van Kampen, J, Pas, S, Driessen, G, van Rossum, A, Van Der Knaap, L, Visser, E, Branger, J, Rijkeboer-Mes, A, Duijf-Van De Ven, C, Schippers, E, van Nieuwkoop, C, van IJperen, J, Geilings, J, van der Hut, G, Franck, P, Van Eeden, A, Brokking, W, Groot, M, Elsenburg, L, Damen, M, Kwa, I, Groeneveld, P, Bouwhuis, J, Van Den Berg, J, Van Hulzen, A, Van Der Bliek, G, Bor, P, Bloembergen, P, Wolfhagen, M, Ruijs, G, Kroon, F, De Boer, M, Bauer, M, Jolink, H, Vollaard, A, Dorama, W, Van Holten, N, Claas, E, Wessels, E, Den Hollander, J, Pogany, K, Roukens, A, Kastelijns, M, Smit, J, Smit, E, Struik-Kalkman, D, Tearno, C, Bezemer, M, van Niekerk, T, Pontesilli, O, Lowe, S, Oude Lashof, A, Posthouwer, D, Ackens, R, Schippers, J, Vergoossen, R, Weijenberg-Maes, B, van Loo, I, Havenith, T, Leyten, E, Gelinck, L, van Hartingsveld, A, Meerkerk, C, Wildenbeest, G, Mutsaers, J, Jansen, C, Mulder, J, Vrouenraets, S, Lauw, F, van Broekhuizen, M, Paap, H, Vlasblom, D, Smits, P, Weijer, S, El Moussaoui, R, Bosma, A, van Vonderen, M, van Houte, D, Kampschreur, L, Dijkstra, K, Faber, S, Weel, J, Kootstra, G, Delsing, C, van der Burg-Van de Plas, M, Heins, H, Lucas, E, Kortmann, W, van Twillert, G, Cohen Stuart, J, Diederen, B, van Truijen-Oud, F, van der Reijden, W, Jansen, R, Brinkman, K, van den Berk, G, Blok, W, Frissen, P, Lettinga, K, Schouten, W, Veenstra, J, Brouwer, J, Geerders, F, Hoeksema, K, Kleene, J, van der Meche, B, Spelbrink, M, Sulman, H, Toonen, A, Wijnands, S, Kwa, D, Witte, E, Koopmans, P, Keuter, M, van der Ven, A, ter Hofstede, H, Dofferhoff, A, van Crevel, R, Albers, M, Bosch, M, Grintjes-Huisman, K, Zomer, J, Stelma, F, Rahamat-Langendoen, J, Burger, D, Richter, C, Gisolf, H, Hassing, J, 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, B, Veenendaal, D, Verhagen, W, van Wijk, M, van Kasteren, M, Brouwer, E, de Kruijf-Van de Wiel, B, Kuipers, M, Santegoets, R, van der Ven, B, Marcelis, H, Buiting, A, Kabel, J, Bierman, W, Scholvinck, H, Wilting, R, Stienstra, Y, de Groot-De Jonge, H, van der Meulen, A, de Weerd, A, Ludwig-Roukema, J, Niesters, H, Riezebos-Brilman, A, van Leer-Buter, C, Knoester, M, Hoepelman, A, Mudrikova, T, Ellerbroek, M, Oosterheert, J, Arends, E, Barth, E, Wassenberg, M, Schadd, M, van Elst-Laurijssen, D, van Oers-Hazelzet, B, Vervoort, S, van Berkel, M, Schuurman, R, Verduyn-Lunel, F, Wensing, A, Peters, E, van Agtmael, A, Bomers, M, de Vocht, J, Heitmuller, M, Laan, M, Pettersson, M, Vandenbroucke-Grauls, C, Ang, W, Geelen, S, Wolfs, T, Bont, J, Nauta, N, Bezemer, O, van Sighem, I, Boender, S, de Jong, A, Bergsma, D, Hoekstra, P, de Lang, A, Grivell, S, Jansen, A, Rademaker, J, Raethke, M, Meijering, R, Schnorr, 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, Mercie, P, Neau, D, Pellegrin, L, Tchamgoue, S, Lazaro, E, Cazanave, C, Vandenhende, M, Vareil, O, Gerard, Y, Blanco, P, Bouchet, S, Breilh, D, Fleury, H, Pellegrin, I, Chene, G, Thiebaut, R, Wittkop, L, Lawson-Ayayi, S, Gimbert, A, Desjardin, S, Lacaze-Buzy, L, Petrov-Sanchez, V, Andre, N, Bernard, K, Caubet, O, Caunegre, L, Chossat, I, Courtault, C, Dauchy, A, Dondia, D, Duffau, P, Dutronc, H, Farbos, S, Faure, I, Ferrand, H, Greib, C, Hessamfar, M, Imbert, Y, Lataste, P, Marie, J, Mechain, M, Monlun, E, Ochoa, A, Pistone, T, Raymond, I, Receveur, C, Rispal, P, Sorin, L, Valette, C, Viallard, J, Wille, H, Wirth, G, Lafon, M, Trimoulet, P, Bellecave, P, Tumiotto, C, Haramburu, F, Miremeont-Salame, G, Blaizeau, J, Decoin, M, Hannapier, C, Lenaud, E, Pougetoux, A, 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, A, Gatell, J, Del Cacho, E, Cadafalch, J, Fuster, M, Codina, C, Sirera, G, Vaque, A, Clumeck, N, Gennotte, F, Gerard, M, Kabeya, K, Konopnicki, D, Libois, A, Martin, C, Payen, C, Semaille, P, Van Laethem, Y, Neaton, J, El-Sadr, M, Krum, E, Thompson, G, Wentworth, D, Luskin-Hawk, R, Telzak, E, Abrams, I, Cohn, D, Markowitz, N, Arduino, R, Mushatt, D, Friedland, G, Perez, G, Tedaldi, E, Fisher, E, Gordin, F, Crane, R, Sampson, J, Baxter, J, Gazzard, B, Horban, A, Karpov, I, Pedersen, C, Ristola, M, Rockstroh, J, Peters, L, Fischer, H, Larsen, F, Podlekareva, D, Cozzi-Lepri, A, Shepherd, L, Schultze, A, Amele, S, Losso, M, Kundro, M, Schmied, B, Zangerle, R, Vassilenko, A, Mitsura, M, Paduto, D, Florence, E, Vandekerckhove, L, Hadziosmanovic, V, Begovac, J, Machala, L, Jilich, D, Sedlacek, D, Kronborg, G, Benfield, T, Gerstoft, J, Katzenstein, T, Moller, F, Ostergaard, L, Wiese, L, Nielsen, N, Zilmer, K, Smidt, J, Aho, I, Viard, J, Girard, P, Duvivier, C, Schmidt, R, Degen, O, Stellbrink, J, Stefan, C, Bogner, J, Chkhartishvili, N, Gargalianos, P, Xylomenos, G, Armenis, K, Sambatakou, H, Szlavik, J, Gottfredsson, M, Mulcahy, F, Yust, I, Turner, D, Burke, M, Shahar, E, Hassoun, G, Elinav, H, Haouzi, M, Elbirt, D, Sthoeger, M, 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, Matulionyte, R, Staub, T, Hemmer, R, 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, Mansinho, K, Maltez, F, Radoi, R, Oprea, C, Panteleev, A, Panteleev, O, Yakovlev, A, Trofimora, T, Khromova, I, Kuzovatova, E, Borodulina, E, Vdoushkina, E, Jevtovic, D, Tomazic, J, Miro, M, Moreno, S, Rodriguez, J, Clotet, B, Jou, A, Paredes, R, Tural, C, Puig, J, Bravo, I, Gutierrez, M, Mateo, G, Laporte, M, Falconer, K, Thalme, A, Sonnerborg, A, Blaxhult, A, Flamholc, L, Cavassini, M, Calmy, A, Furrer, H, Battegay, M, Schmid, P, Kuznetsova, A, Kyselyova, G, Sluzhynska, M, Johnson, A, Simons, E, Orkin, C, Weber, J, Scullard, G, Clarke, A, Leen, C, Thulin, G, Akerlund, B, Koppel, K, Karlsson, A, Hakangard, C, Castelli, F, Cauda, R, Di Perri, G, Iardino, R, Ippolito, G, Marchetti, C, Perno, F, 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, R, Cingolani, A, Cinque, P, De Luca, A, Di Biagio, A, Gori, A, Guaraldi, G, Lapadula, G, Madeddu, G, Maggiolo, F, Marcotullio, S, Monno, L, Nozza, S, Quiros Roldan, E, Rossotti, R, Rusconi, S, Santoro, M, 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, E, 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, C, Piolini, R, Ridolfo, L, Salpietro, S, Tincati, C, Puzzolante, C, Abrescia, N, Chirianni, A, Borgia, G, Orlando, R, Bonadies, G, Di Martino, F, Gentile, I, Maddaloni, L, Cattelan, M, Marinello, S, Cascio, A, Colomba, C, Baldelli, F, Schiaroli, E, Parruti, G, Sozio, F, Magnani, G, Ursitti, A, Cristaudo, A, Baldin, G, Capozzi, M, Cicalini, S, Fontanelli Sulekova, L, Iaiani, G, Latini, A, Mastrorosa, I, 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, C, Sciandra, M, Bassetti, M, Londero, A, Pellizzer, G, Manfrin, V, Starnini, G, Ialungo, A, 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, M, Aubert, V, Bernasconi, E, Ciuffi, A, Dollenmaier, G, Egger, M, Elzi, L, Fehr, J, Fellay, J, Gunthard, F, Haerry, D, Hasse, B, Hirsch, H, Hoffmann, M, Hosli, I, Kahlert, C, Kaiser, L, Keiser, O, Klimkait, T, Kouyos, D, Kovari, H, Ledergerber, B, Martinetti, G, Martinez de Tejada, B, Marzolini, C, Metzner, J, Muller, N, Nicca, D, Pantaleo, G, Paioni, P, Rauch, A, Rudin, C, Speck, R, Stockle, M, Tarr, P, Trkola, A, Vernazza, P, Wandeler, G, Yerly, S, Internal medicine, Pediatric surgery, Medical Microbiology and Infection Prevention, Amsterdam Gastroenterology Endocrinology Metabolism, Faculteit Medische Wetenschappen/UMCG, Microbes in Health and Disease (MHD), and Molecular Pharmacology

Subjects
Male, HIV AIDS, HIV Infections, 0302 clinical medicine, Interquartile range, Risk Factors, Neoplasms, Medicine, 030212 general & internal medicine, Prospective Studies, Prospective cohort study, 0303 health sciences, Incidence, Absolute risk reduction, Drugs, General Medicine, Middle Aged, Viral Load, Antiretroviral therapy, 3. Good health, AIDS, Cancer treatment, Prevention policy and public health, Cohort, Infectious diseases, Cohort studies, Female, Viral load, Adult, medicine.medical_specialty, Anti-HIV Agents, HIV Infections/drug therapy, Socio-culturale, Time-to-Treatment, 03 medical and health sciences, Acquired immunodeficiency syndrome (AIDS), SDG 3 - Good Health and Well-being, Internal medicine, Internal Medicine, Humans, Adverse effect, 030306 microbiology, business.industry, HIV, Cancer, medicine.disease, CD4 Lymphocyte Count, Anti-HIV Agents/therapeutic use, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business, Neoplasms/epidemiology
Abstract

BACKGROUND: Immediate initiation of antiretroviral therapy (ART) regardless of CD4 cell count reduces risk for AIDS and non-AIDS-related events in asymptomatic, HIV-positive persons and is the standard of care. However, most HIV-positive persons initiate ART when their CD4 count decreases below 500 × 10 9 cells/L. Consequences of delayed ART on risk for non-AIDS-defining and AIDS-defining cancer, one of the most common reasons for death in HIV, are unclear. OBJECTIVE: To estimate the long-term risk difference for cancer with the immediate ART strategy.DESIGN: Multinational prospective cohort study.SETTING: The D:A:D (Data collection on Adverse events of anti-HIV Drugs) study, which included HIV-positive persons from Europe, Australia, and the United States.PARTICIPANTS: 8318 HIV-positive persons with at least 1 measurement each of CD4 cell count and viral load while ART-naive (study period, 2006 to 2016).MEASUREMENTS: The parametric g-formula was used, with adjustment for baseline and time-dependent confounders (CD4 cell count and viral load), to assess the 10-year risk for non-AIDS-defining and AIDS-defining cancer of immediate versus deferred (at CD4 counts RESULTS: During 64 021 person-years of follow-up, 231 cases of non-AIDS-defining cancer and 272 of AIDS-defining cancer occurred among HIV-positive persons with a median age of 36 years (interquartile range, 29 to 43 years). With immediate ART, the 10-year risk for non-AIDS-defining cancer was 2.97% (95% CI, 2.37% to 3.50%) and that for AIDS-defining cancer was 2.50% (CI, 2.37% to 3.38%). Compared with immediate ART initiation, the 10-year absolute risk differences when deferring ART to CD4 counts less than 500 × 10 9 cells/L and less than 350 × 10 9 cells/L were 0.12 percentage point (CI, -0.01 to 0.26 percentage point) and 0.29 percentage point (CI, -0.03 to 0.73 percentage point), respectively, for non-AIDS-defining cancer and 0.32 percentage point (CI, 0.21 to 0.44 percentage point) and 1.00 percentage point (CI, 0.67 to 1.44 percentage points), respectively, for AIDS-defining cancer. LIMITATION: Potential residual confounding due to observational study design.CONCLUSION: In this young cohort, effects of immediate ART on 10-year risk for cancer were small, and further supportive data are needed for non-AIDS-defining cancer.PRIMARY FUNDING SOURCE: Highly Active Antiretroviral Therapy Oversight Committee.

Published
2021

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