TY - JOUR
T1 - Prevalence and Outcomes for Heavily Treatment-Experienced Individuals Living With Human Immunodeficiency Virus in a European Cohort
AU - EuroSIDA study
AU - Pelchen-Matthews, Annegret
AU - Borges, Álvaro H.
AU - Reekie, Joanne
AU - Rasmussen, Line D.
AU - Wiese, Lothar
AU - Weber, Jonathan
AU - Pradier, Christian
AU - Degen, Olaf
AU - Paredes, Roger
AU - Tau, Luba
AU - Flamholc, Leo
AU - Gottfreðsson, Magnús
AU - Kowalska, Justyna
AU - Jablonowska, Elzbieta
AU - Mozer-Lisewska, Iwona
AU - Radoi, Roxana
AU - Vasylyev, Marta
AU - Kuznetsova, Anastasiia
AU - Begovac, Josip
AU - Svedhem, Veronica
AU - Clark, Andrew
AU - Cozzi-Lepri, Alessandro
N1 - Publisher Copyright:
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
Funding text
The EUVAS group was supported by grants from the EU (Contract no.s BMH1-CT93-1078, CIPDCT94-0307, BMH4-CT97-2328, and ERBIC20-CT97-0019). The following investigators participated in the European Vasculitis Study group (EUVAS):
PY - 2021/6/1
Y1 - 2021/6/1
N2 - BACKGROUND: Although antiretroviral treatments have improved survival of persons living with HIV, their long-term use may limit available drug options. We estimated the prevalence of heavily treatment-experienced (HTE) status and the potential clinical consequences of becoming HTE.SETTING: EuroSIDA, a European multicenter prospective cohort study.METHODS: A composite definition for HTE was developed, based on estimates of antiretroviral resistance and prior exposure to specific antiretroviral regimens. Risks of progressing to clinical outcomes were assessed by Poisson regression, comparing every HTE individual with 3 randomly selected controls who never became HTE.RESULTS: Of 15,570 individuals under follow-up in 2010-2016, 1617 (10.4%, 95% CI: 9.9% to 10.9%) were classified as HTE. 1093 individuals became HTE during prospective follow-up (HTE incidence rate 1.76, CI: 1.66 to 1.87 per 100 person-years of follow-up). The number of HTE individuals was highest in West/Central Europe (636/4019 persons, 15.7%) and lowest in East Europe (26/2279 persons, 1.1%). Although most HTE individuals maintained controlled viral loads (<400 copies/mL), many had low CD4 counts (≤350 cells/µL). After controlling for age, immunological parameters and pre-existing comorbidities, HTE status was not associated with the risk of new AIDS (adjusted incidence rate ratio, aIRR 1.44, CI: 0.86 to 2.40, P = 0.16) or non-AIDS clinical events (aIRR 0.96, CI: 0.74 to 1.25, P = 0.77).CONCLUSIONS: HTE prevalence increased with time. After adjusting for key confounding factors, there was no evidence for an increased risk of new AIDS or non-AIDS clinical events in HTE. Additional therapeutic options and effective management of comorbidities remain important to reduce clinical complications in HTE individuals.
AB - BACKGROUND: Although antiretroviral treatments have improved survival of persons living with HIV, their long-term use may limit available drug options. We estimated the prevalence of heavily treatment-experienced (HTE) status and the potential clinical consequences of becoming HTE.SETTING: EuroSIDA, a European multicenter prospective cohort study.METHODS: A composite definition for HTE was developed, based on estimates of antiretroviral resistance and prior exposure to specific antiretroviral regimens. Risks of progressing to clinical outcomes were assessed by Poisson regression, comparing every HTE individual with 3 randomly selected controls who never became HTE.RESULTS: Of 15,570 individuals under follow-up in 2010-2016, 1617 (10.4%, 95% CI: 9.9% to 10.9%) were classified as HTE. 1093 individuals became HTE during prospective follow-up (HTE incidence rate 1.76, CI: 1.66 to 1.87 per 100 person-years of follow-up). The number of HTE individuals was highest in West/Central Europe (636/4019 persons, 15.7%) and lowest in East Europe (26/2279 persons, 1.1%). Although most HTE individuals maintained controlled viral loads (<400 copies/mL), many had low CD4 counts (≤350 cells/µL). After controlling for age, immunological parameters and pre-existing comorbidities, HTE status was not associated with the risk of new AIDS (adjusted incidence rate ratio, aIRR 1.44, CI: 0.86 to 2.40, P = 0.16) or non-AIDS clinical events (aIRR 0.96, CI: 0.74 to 1.25, P = 0.77).CONCLUSIONS: HTE prevalence increased with time. After adjusting for key confounding factors, there was no evidence for an increased risk of new AIDS or non-AIDS clinical events in HTE. Additional therapeutic options and effective management of comorbidities remain important to reduce clinical complications in HTE individuals.
KW - Acquired Immunodeficiency Syndrome/drug therapy
KW - Adult
KW - Anti-HIV Agents/therapeutic use
KW - Antiretroviral Therapy, Highly Active
KW - Comorbidity
KW - Europe/epidemiology
KW - Female
KW - Humans
KW - Male
KW - Middle Aged
KW - Prospective Studies
KW - Treatment Outcome
KW - Viral Load/drug effects
UR - http://www.scopus.com/inward/record.url?scp=85106666627&partnerID=8YFLogxK
U2 - 10.1097/QAI.0000000000002635
DO - 10.1097/QAI.0000000000002635
M3 - Article
C2 - 33587506
AN - SCOPUS:85106666627
SN - 1525-4135
VL - 87
SP - 806
EP - 817
JO - Journal of acquired immune deficiency syndromes (1999)
JF - Journal of acquired immune deficiency syndromes (1999)
IS - 2
ER -