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Immuno-virological discordance and the risk of non-AIDS and AIDS events in a large observational cohort of HIV-patients in Europe

(2014) PLOS ONE. 9(1).
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Abstract
Background: The impact of immunosuppression despite virological suppression (immuno-virological discordance, ID) on the risk of developing fatal and non-fatal AIDS/non-AIDS events is unclear and remains to be elucidated. Methods: Patients in EuroSIDA starting at least 1 new antiretroviral drug with CD4<350 cells/mu l and viral load (VL)>500 copies/mL were followed-up from the first day of VL<=50 copies/ml until a new fatal/non-fatal non-AIDS/AIDS event. Considered non-AIDS events included non-AIDS malignancies, pancreatitis, severe liver disease with hepatic encephalopathy (>grade 3), cardio-and cerebrovascular events, and end-stage renal disease. Patients were classified over time according to whether current CD4 count was above (non-ID) or below (ID) baseline level. Relative rates (RR) of events were calculated for ID vs. non-ID using adjusted Poisson regression models. Results: 2,913 patients contributed 11,491 person-years for the analysis of non-AIDS. 241 pre-specified non-AIDS events (including 84 deaths) and 89 AIDS events (including 10 deaths) occurred. The RR of developing pre-specified non-AIDS events for ID vs. non-ID was 1.96 (95% CI 1.37-2.81, p<0.001) in unadjusted analysis and 1.43 (0.94-2.17, p = 0.095) after controlling for current CD4 count. ID was not associated with the risk of AIDS events (aRR 0.76, 95% CI 0.41-1.38, p = 0.361). Conclusion: Compared to CD4 responders, patients with immuno-virological discordance may be at increased risk of developing non-AIDS events. Further studies are warranted to establish whether in patients with ID, strategies to directly modify CD4 count response may be needed besides the use of ART.
Keywords
COMBINATION ANTIRETROVIRAL THERAPY, CLINICAL-TRIALS GROUP, CD4 CELL COUNT, INFECTED PATIENTS, DEFINING MALIGNANCIES, IMMUNODEFICIENCY, MORTALITY, PROGRESSION, SUPPRESSION, RESPONSES

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Chicago
Zoufaly, Alexander, Alessandro Cozzi-Lepri, Joanne Reekie, Ole Kirk, Jens Lundgren, Peter Reiss, Djordje Jevtovic, et al. 2014. “Immuno-virological Discordance and the Risk of non-AIDS and AIDS Events in a Large Observational Cohort of HIV-patients in Europe.” Plos One 9 (1).
APA
Zoufaly, A., Cozzi-Lepri, A., Reekie, J., Kirk, O., Lundgren, J., Reiss, P., Jevtovic, D., et al. (2014). Immuno-virological discordance and the risk of non-AIDS and AIDS events in a large observational cohort of HIV-patients in Europe. PLOS ONE, 9(1).
Vancouver
1.
Zoufaly A, Cozzi-Lepri A, Reekie J, Kirk O, Lundgren J, Reiss P, et al. Immuno-virological discordance and the risk of non-AIDS and AIDS events in a large observational cohort of HIV-patients in Europe. PLOS ONE. 2014;9(1).
MLA
Zoufaly, Alexander et al. “Immuno-virological Discordance and the Risk of non-AIDS and AIDS Events in a Large Observational Cohort of HIV-patients in Europe.” PLOS ONE 9.1 (2014): n. pag. Print.
@article{4350885,
  abstract     = {Background: The impact of immunosuppression despite virological suppression (immuno-virological discordance, ID) on the risk of developing fatal and non-fatal AIDS/non-AIDS events is unclear and remains to be elucidated.
Methods: Patients in EuroSIDA starting at least 1 new antiretroviral drug with CD4<350 cells/mu l and viral load (VL)>500 copies/mL were followed-up from the first day of VL<=50 copies/ml until a new fatal/non-fatal non-AIDS/AIDS event. Considered non-AIDS events included non-AIDS malignancies, pancreatitis, severe liver disease with hepatic encephalopathy (>grade 3), cardio-and cerebrovascular events, and end-stage renal disease. Patients were classified over time according to whether current CD4 count was above (non-ID) or below (ID) baseline level. Relative rates (RR) of events were calculated for ID vs. non-ID using adjusted Poisson regression models.
Results: 2,913 patients contributed 11,491 person-years for the analysis of non-AIDS. 241 pre-specified non-AIDS events (including 84 deaths) and 89 AIDS events (including 10 deaths) occurred. The RR of developing pre-specified non-AIDS events for ID vs. non-ID was 1.96 (95% CI 1.37-2.81, p<0.001) in unadjusted analysis and 1.43 (0.94-2.17, p = 0.095) after controlling for current CD4 count. ID was not associated with the risk of AIDS events (aRR 0.76, 95% CI 0.41-1.38, p = 0.361).
Conclusion: Compared to CD4 responders, patients with immuno-virological discordance may be at increased risk of developing non-AIDS events. Further studies are warranted to establish whether in patients with ID, strategies to directly modify CD4 count response may be needed besides the use of ART.},
  articleno    = {e87160},
  author       = {Zoufaly, Alexander and Cozzi-Lepri, Alessandro and Reekie, Joanne and Kirk, Ole and Lundgren, Jens and Reiss, Peter and Jevtovic, Djordje and Machala, Ladislav and Zangerle, Robert and Mocroft, Amanda and Van Lunzen, Jan and EuroSIDA study group, the and Vandekerckhove, Linos},
  issn         = {1932-6203},
  journal      = {PLOS ONE},
  keywords     = {COMBINATION ANTIRETROVIRAL THERAPY,CLINICAL-TRIALS GROUP,CD4 CELL COUNT,INFECTED PATIENTS,DEFINING MALIGNANCIES,IMMUNODEFICIENCY,MORTALITY,PROGRESSION,SUPPRESSION,RESPONSES},
  language     = {eng},
  number       = {1},
  pages        = {10},
  title        = {Immuno-virological discordance and the risk of non-AIDS and AIDS events in a large observational cohort of HIV-patients in Europe},
  url          = {http://dx.doi.org/10.1371/journal.pone.0087160},
  volume       = {9},
  year         = {2014},
}

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