HIV treatment outcomes after 10 years on ART in the TREAT Asia Observational Database (TAHOD) and Australian HIV Observational Database (AHOD).

IF 2.9 3区医学 Q3 IMMUNOLOGY

JAIDS Journal of Acquired Immune Deficiency Syndromes Pub Date : 2024-08-22 DOI:10.1097/QAI.0000000000003515

Awachana Jiamsakul, Dhanushi Rupasinghe, Ian Woolley, Jun Yong Choi, David J Templeton, Alvina Widhani, Kathy Petoumenos, Junko Tanuma

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引用次数: 0

Abstract

Background: Increasing numbers of people with HIV have received prolonged antiretroviral therapy (ART). We assessed long-term immunological and survival outcomes among people with HIV from Asia (TAHOD) and Australia (AHOD).

Methods: People with HIV receiving ART for ≥10 years were included. Factors associated with CD4 counts in years 11-15 of ART were analysed using repeated measure linear regression. Survival after 10 years was analysed using competing risk regression.

Results: There were 7139 people included: 4867 (68%) from TAHOD and 2272 (32%) from AHOD. Higher CD4 after 10 years were observed if the nadir CD4 in the first decade was higher (CD4 (cells/µL) 101-200: difference=35, 95%CI 18, 51; >200: difference=125, 95%CI 107, 142) compared to ≤50. The same patterns were observed in those who achieved CD4 ≥500 cells/µL which subsequently decreased to <500 (difference=225, 95%CI 213, 236); or those who achieved and maintained CD4 ≥500 cells/µL (difference=402, 95%CI 384, 420), compared to always <500 in the previous decade. Prior protease inhibitor (PI) -based regimen (difference=-17, 95%CI -33, -1) compared to no PI, and previous treatment interruptions (TI) of 14 days to 3 months and >6 months were associated with lower CD4 counts after 10 years (difference = -38, 95%CI -62, -15; and difference=-44, 95%CI -61, -27, respectively) compared to no TI. The mortality rate was 1.04 per 100 person-years. Virological failure was associated with subsequent mortality (sub-hazard ratio=1.34, 95%CI 1.04, 1.71).

Conclusions: Sustaining high CD4 levels and minimising TI has far-reaching benefits well beyond the first decade of ART.

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TREAT 亚洲观察数据库（TAHOD）和澳大利亚艾滋病观察数据库（AHOD）中接受抗逆转录病毒疗法 10 年后的艾滋病治疗效果。

背景：越来越多的艾滋病病毒感染者接受了长期抗逆转录病毒疗法（ART）。我们对来自亚洲（TAHOD）和澳大利亚（AHOD）的艾滋病病毒感染者的长期免疫和生存结果进行了评估：方法：纳入接受抗逆转录病毒疗法≥10 年的 HIV 感染者。方法：纳入接受抗逆转录病毒疗法≥10 年的艾滋病病毒感染者，采用重复测量线性回归分析与抗逆转录病毒疗法第 11-15 年 CD4 细胞计数相关的因素。使用竞争风险回归分析 10 年后的存活率：结果：共纳入 7139 人：结果：共纳入 7139 人：4867 人（68%）来自 TAHOD，2272 人（32%）来自 AHOD。如果前十年的最低 CD4 较高（CD4（细胞/微升）101-200：差异=35，95%CI 18，51；>200：差异=125，95%CI 107，142），则 10 年后的 CD4 高于≤50。CD4 细胞数≥500 个/µL，随后下降到 6 个月的患者与无 TI 患者相比，10 年后 CD4 细胞数下降（分别为差异=-38，95%CI -62，-15；差异=-44，95%CI -61，-27），也观察到同样的模式。死亡率为每100人年1.04例。病毒学失败与随后的死亡率相关（次危险比=1.34，95%CI 1.04，1.71）：结论：维持较高的 CD4 水平并将 TI 降到最低，在抗逆转录病毒疗法的第一个十年后仍有深远的益处。

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来源期刊

JAIDS Journal of Acquired Immune Deficiency Syndromes 医学-传染病学

CiteScore

5.80

自引率

5.60%

发文量

490

审稿时长

3-6 weeks

期刊介绍： JAIDS: Journal of Acquired Immune Deficiency Syndromes seeks to end the HIV epidemic by presenting important new science across all disciplines that advance our understanding of the biology, treatment and prevention of HIV infection worldwide. JAIDS: Journal of Acquired Immune Deficiency Syndromes is the trusted, interdisciplinary resource for HIV- and AIDS-related information with a strong focus on basic and translational science, clinical science, and epidemiology and prevention. Co-edited by the foremost leaders in clinical virology, molecular biology, and epidemiology, JAIDS publishes vital information on the advances in diagnosis and treatment of HIV infections, as well as the latest research in the development of therapeutics and vaccine approaches. This ground-breaking journal brings together rigorously peer-reviewed articles, reviews of current research, results of clinical trials, and epidemiologic reports from around the world.