Universidad Peruana Cayetano Heredia

Clinical effects of durability of immunosuppression in virologically suppressed ART-initiating persons with HIV in Latin America. A retrospective cohort study

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dc.contributor.author Caro-Vega, Yanink
dc.contributor.author Rebeiro, Peter F.
dc.contributor.author Shepherd, Bryan E.
dc.contributor.author Belaunzarán-Zamudio, Pablo F.
dc.contributor.author Crabtree-Ramirez, Brenda
dc.contributor.author Cesar, Carina
dc.contributor.author Mendes Luz, Paula
dc.contributor.author Cortes, Claudia P.
dc.contributor.author Padget, Denis
dc.contributor.author Gotuzzo Herencia, José Eduardo
dc.contributor.author McGowan, Catherine C.
dc.contributor.author Sierra-Madero, Juan G.
dc.date.accessioned 2022-04-26T17:26:49Z
dc.date.available 2022-04-26T17:26:49Z
dc.date.issued 2022
dc.identifier.uri https://hdl.handle.net/20.500.12866/11595
dc.description.abstract Background: Clinical outcomes are rarely studied in virologically suppressed people living with HIV (PWH) and incomplete CD4 recovery. To explore whether time living with severe immunosuppression predict clinical outcomes better than baseline or time updated CD4, we estimated the association between cumulative percentage of time with CD4 <200 cells/µL during viral suppression (VS) (%tCD4<200), and mortality and comorbidities during 2000-2019. Methods: In a retrospective cohort analysis, we followed PWH initiating ART in Latin America from first VS (HIV-RNA<200 copies/µL) to death, virological failure or loss to follow-up. We fit Cox models to estimate risk of death and/or AIDS-defining and serious non-AIDS-defining events (ADE and SNADE -cancer, cardiovascular, liver, and renal diseases) by %tCD4<200 (continuous variable). We predicted survival probabilities for each event and calculated risks of hypothetical cases of different %tCD4<200. Findings: In 8,369 patients with 34·9 months of follow-up (median, IQR: 16·7, 69·1), 4,274 (51%) started ART with CD4<200 cells/µL. Median %tCD4<200 was 0% (IQR: 0, 15%). We identified 195 (2·3%) deaths and 584 (7·2%) patients with ADE/SNADE. For an increased %tCD4<200 of 15% (e.g., 15% vs. 0%), the adjusted relative hazard (aHR) of death was 1·27 (95% confidence interval [CI]: 1·19 – 1·35), of ADE/SNADE was 1·13 (95%CI: 1·09 – 1·17), of SNADE was 0·96 (95%CI: 0·89 – 1·02) and of death/ADE/SNADE was 1·11 (95%CI: 1·07 – 1·14). Estimates were similar after adjusting for time updated CD4 count. Interpretation: In virologically suppressed PWH, increased time living with severe immunosuppression had an increased risk of death and ADE/SNADE in this Latin American cohort, independently of time updated CD4 count. en_US
dc.language.iso eng
dc.publisher Elsevier
dc.relation.ispartofseries Lancet Regional Health. Americas
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject Latin America en_US
dc.subject HIV en_US
dc.subject AIDS defining and non-AIDS defining events en_US
dc.subject cumulative low CD4 counts en_US
dc.subject Sustained Virologic Response en_US
dc.title Clinical effects of durability of immunosuppression in virologically suppressed ART-initiating persons with HIV in Latin America. A retrospective cohort study en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.1016/j.lana.2021.100175
dc.relation.issn 2667-193X


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