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Mortality and immunovirological outcomes in patients with advanced HIV disease on their first antiretroviral treatment: differential impact of antiretroviral regimens

2022; Oxford University Press; Volume: 78; Issue: 1 Linguagem: Inglês

10.1093/jac/dkac361

1460-2091

Joaquín Burgos, Sergio Moreno‐Fornés, Juliana Reyes‐Urueña, Andreu Bruguera, Raquel Martín-Iguacel, Berta Raventós, Josep M. Llibre, Arkaitz Imaz, Joaquim Peraire, Amat-Joaquim Orti, David Dalmau, Jordi Casabona, Josep M. Miró, Vicenç Falcó, Esteve Muntada, Anna Esteve‐Codina, Francisco Fanjul, Vicenç Falcó, Hernando Knobel, Josep Mallolas, Juan Tiraboschi, Adrián Curran, Joaquín Burgos, Boris Revollo, María Pilar Rivero Gracia, María del Mar Gutiérrez, Javier Murillas, Francisco Homar, José Vicente Fernández-Montero, Eva López González, Joaquim Peraire, Lluís Force, Elena León, Miquel Hortos, Ingrid Vilaró, Amat Orti, David Dalmau, Ángeles Jaén, Elisa de Lazzari, Leire Berrocal, Lucía Rodríguez‐Vázquez, Freya Gargoulas, Toni Vanrell, José Carlos, Josep Vilà, Marina Martínez, Bibiana Morell, Maribel Tamayo, Jorge Palacio, Juan Ambrosioni, Montse Laguno, Marı́a Martı́nez-Rebollar, José Luís Blanco, Felipe García, Berta Torres, Lorena de la Mora, Alexy Inciarte, Ainoa Ugarte, Iván Chivite, Ana González-Cordón, Lorna Leal, Antoni Jou, Eugènia Negredo, María Saumoy, Ana Silva, Sofía Scévola, Paula Suanzes, Patricia Álvarez, Isabel Mur, Melchor Riera Jaume, Mercedes García‐Gasalla, Maria Àngels Ribas, Antoni A Campins, María Luz Pintos Peñaranda, Marisa Martín, Helem Haydee, Sònia Calzado, Manel Cervantes, Marta Navarro, Antoni Payeras, Carmen Luna, Aroa Villoslada Gelabert, Patrícia Sorní, Marta Molero, Nadia Abdulghani, Thaïs Comella, Rocio Sola, Montserrat Vargas, Consuleo Viladés, Anna Martí, Elena Yeregui, Anna Rull, Pilar Barrufet, Laia Arbonés, Elena Chamarro, Cristina Escrig, Mireia Cairó, Xavier Martínez-Lacasa, Roser Font, Lizza Macorigh, Juanse Hernández,

HIV Research and Treatment

To assess the clinical and immunovirological outcomes among naive patients with advanced HIV presentation starting an antiretroviral regimen in real-life settings.This was a multicentre, prospective cohort study. We included all treatment-naive adults with advanced HIV disease (CD4+ T cell count < 200 cells/mm3or presence of an AIDS-defining illness) who started therapy between 2010 and 2020. The main outcomes were mortality, virological effectiveness (percentage of patients with viral load of ≤50 copies/mL) and immune restoration (percentage of patients with CD4+ T cell count above 350 cells/mm3). Competing risk analysis and Cox proportional models were performed. A propensity score-matching procedure was applied to assess the impact of the antiretroviral regimen.We included 1594 patients with advanced HIV disease [median CD4+T cell count of 81 cells/mm3and 371 (23.3%) with AIDS-defining illness] and with a median follow-up of 4.44 years. The most common ART used was an integrase strand transfer inhibitor (InSTI) regimen (46.9%), followed by PI (35.7%) and NNRTI (17.4%), with adjusted mortality rates at 3 years of 3.1% (95% CI 1.8%-4.3%), 4.7% (95% CI 2.2%-7.1%) and 7.6% (95% CI 5.4%-9.7%) (P = 0.001), respectively. Factors associated with increased mortality included older age and history of injection drug use, whilst treatment with an InSTI regimen was a protective factor [HR 0.5 (95% CI 0.3-0.9)]. A sensitivity analysis with propensity score procedure confirms these results. Patients who started an InSTI achieved viral suppression and CD4+ T cell count above 350 cells/mm3significantly earlier.In this large real-life prospective cohort study, a significant lower mortality, earlier viral suppression and earlier immune reconstitution were observed among patients with advanced HIV disease treated with InSTIs.