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1. HIV Infection, Immunosuppression, and Age at Diagnosis of Non-AIDS-Defining Cancers

Author

Shiels, Meredith S, Althoff, Keri N, Pfeiffer, Ruth M, Achenbach, Chad J, Abraham, Alison G, Castilho, Jessica, Cescon, Angela, D'Souza, Gypsyamber, Dubrow, Robert, Eron, Joseph J, Gebo, Kelly, John Gill, M, Goedert, James J, Grover, Surbhi, Hessol, Nancy A, Justice, Amy, Kitahata, Mari, Mayor, Angel, Moore, Richard D, Napravnik, Sonia, Novak, Richard M, Thorne, Jennifer E, Silverberg, Michael J, Engels, Eric A, and North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) of the International Epidemiologic Databases to Evaluate AIDS (IeDEA)

Subjects
Adult, Male, HIV Infections, Medical and Health Sciences, Microbiology, Cohort Studies, Young Adult, Rare Diseases, Neoplasms, Immune Tolerance, Humans, cancer, 2.1 Biological and endogenous factors, Dental/Oral and Craniofacial Disease, Aetiology, Lung, Aged, immunosuppression, Prevention, aging, Lung Cancer, Age Factors, HIV, Middle Aged, Biological Sciences, CD4 Lymphocyte Count, AIDS, Infectious Diseases, North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) of the International Epidemiologic Databases to Evaluate AIDS, HIV/AIDS, Female
Abstract

BackgroundIt is unclear whether immunosuppression leads to younger ages at cancer diagnosis among people living with human immunodeficiency virus (PLWH). A previous study found that most cancers are not diagnosed at a younger age in people with AIDS, with the exception of anal and lung cancers. This study extends prior work to include all PLWH and examines associations between AIDS, CD4 count, and age at cancer diagnosis.MethodsWe compared the median age at cancer diagnosis between PLWH in the North American AIDS Cohort Collaboration on Research and Design and the general population using data from the Surveillance, Epidemiology and End Results Program. We used statistical weights to adjust for population differences. We also compared median age at cancer diagnosis by AIDS status and CD4 count.ResultsAfter adjusting for population differences, younger ages at diagnosis (P < .05) were observed for PLWH compared with the general population for lung (difference in medians = 4 years), anal (difference = 4), oral cavity/pharynx (difference = 2), and kidney cancers (difference = 2) and myeloma (difference = 4). Among PLWH, having an AIDS-defining event was associated with a younger age at myeloma diagnosis (difference = 4; P = .01), and CD4 count

Published
2017

2. Does short-term virologic failure translate to clinical events in antiretroviral-naïve patients initiating antiretroviral therapy in clinical practice?: VF & Clinical Events by ART Regimen

Author

Mugavero, Michael, May, Margaret, Harris, Ross, Saag, Michael, Costagliola, Dominique, Egger, Matthias, Phillips, Andrew, Günthard, Huldrych, Dabis, Francois, Hogg, Robert, De Wolf, Frank, Fatkenheuer, Gerd, John Gill, M., Justice, Amy, D'Arminio Monforte, Antonella, Lampe, Fiona, Miró, Jose, Staszewski, Schlomo, Sterne, Jonathan, Division of Infectious Disease, University of Alabama at Birmingham [ Birmingham] (UAB), Department of Social Medicine, University of Bristol [Bristol], Desmond Tutu HIV Centre, University of Cape Town-Institute of Infectious Disease and Molecular Medicine, Epidémiologie Clinique et Traitement de l'Infection à VIH, Université Pierre et Marie Curie - Paris 6 (UPMC)-IFR113-Institut National de la Santé et de la Recherche Médicale (INSERM), Institute of Social and Preventive Medicine, University of Berne, Department of Primary Care and Population Sciences, Royal Free and University College Medical School, Divison of Infectious Diseases and Hospital Epidemiology, University hospital of Zurich [Zurich], Epidémiologie, santé publique et développement, Université Bordeaux Segalen - Bordeaux 2-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR99-ISPED, Division of Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Academisch Medisch Centrum bij, Universiteit van Amsterdam (UvA), Department of Internal Medicine, University of Cologne, Division of Infectious Diseases, University of Calgary, Yale University School of Medicine, Clinic of Infectious Diseases & Tropical Medicine, 'San Paolo' Hospital-University of Milan, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona (UB), Zentrum der Inneren Medizin, Goethe-Universität Frankfurt am Main, Universität Bern [Bern] (UNIBE), Yale School of Medicine [New Haven, Connecticut] (YSM), and Università degli Studi di Milano = University of Milan (UNIMI)-'San Paolo' Hospital

Subjects
AIDS, virus diseases, HIV, Antiretroviral Therapy, Highly Active, Viral load, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Cohort analysis, AIDS-related Opportunistic Infections, Mortality
Abstract

International audience; OBJECTIVE: To determine whether differences in short-term virologic failure among commonly used antiretroviral therapy (ART) regimens translate to differences in clinical events in antiretroviral-na? patients initiating ART. DESIGN: Observational cohort study of patients initiating ART between January 2000 and December 2005. SETTING: The Antiretroviral Therapy Cohort Collaboration (ART-CC) is a collaboration of 15 HIV cohort studies from Canada, Europe, and the United States. STUDY PARTICIPANTS: A total of 13 546 antiretroviral-na? HIV-positive patients initiating ART with efavirenz, nevirapine, lopinavir/ritonavir, nelfinavir, or abacavir as third drugs in combination with a zidovudine and lamivudine nucleoside reverse transcriptase inhibitor backbone. MAIN OUTCOME MEASURES: Short-term (24-week) virologic failure (>500 copies/ml) and clinical events within 2 years of ART initiation (incident AIDS-defining event, death, and a composite measure of these two outcomes). RESULTS: Compared with efavirenz as initial third drug, short-term virologic failure was more common with all other third drugs evaluated; nevirapine (adjusted odds ratio = 1.87, 95% confidence interval (CI) = 1.58-2.22), lopinavir/ritonavir (1.32, 95% CI = 1.12-1.57), nelfinavir (3.20, 95% CI = 2.74-3.74), and abacavir (2.13, 95% CI = 1.82-2.50). However, the rate of clinical events within 2 years of ART initiation appeared higher only with nevirapine (adjusted hazard ratio for composite outcome measure 1.27, 95% CI = 1.04-1.56) and abacavir (1.22, 95% CI = 1.00-1.48). CONCLUSION: Among antiretroviral-na? patients initiating therapy, between-ART regimen, differences in short-term virologic failure do not necessarily translate to differences in clinical outcomes. Our results should be interpreted with caution because of the possibility of residual confounding by indication.

Published
2008
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3. Does short-term virologic failure translate to clinical events in antiretroviral-naïve patients initiating antiretroviral therapy in clinical practice?: VF & Clinical Events by ART Regimen

Author

Mugavero, Michael, May, Margaret, Harris, Ross, Saag, Michael, Costagliola, Dominique, Egger, Matthias, Phillips, Andrew, Günthard, Huldrych, Dabis, Francois, Hogg, Robert, de Wolf, Frank, Fatkenheuer, Gerd, John Gill, M., Justice, Amy, d'Arminio Monforte, Antonella, Lampe, Fiona, Miró, Jose, Staszewski, Schlomo, Sterne, Jonathan, Mouillet, Evelyne, Division of Infectious Disease, University of Alabama at Birmingham [ Birmingham] (UAB), Department of Social Medicine, University of Bristol [Bristol], Desmond Tutu HIV Centre, University of Cape Town-Institute of Infectious Disease and Molecular Medicine, Epidémiologie Clinique et Traitement de l'Infection à VIH, Université Pierre et Marie Curie - Paris 6 (UPMC)-IFR113-Institut National de la Santé et de la Recherche Médicale (INSERM), Institute of Social and Preventive Medicine, Universität Bern [Bern] (UNIBE), Department of Primary Care and Population Sciences, Royal Free and University College Medical School, Divison of Infectious Diseases and Hospital Epidemiology, University hospital of Zurich [Zurich], Epidémiologie, santé publique et développement, Université Bordeaux Segalen - Bordeaux 2-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR99-ISPED, Division of Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Academisch Medisch Centrum bij, Universiteit van Amsterdam (UvA), Department of Internal Medicine, University of Cologne, Division of Infectious Diseases, University of Calgary, Yale School of Medicine [New Haven, Connecticut] (YSM), Clinic of Infectious Diseases & Tropical Medicine, Università degli Studi di Milano = University of Milan (UNIMI)-'San Paolo' Hospital, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona (UB), Zentrum der Inneren Medizin, and Goethe-Universität Frankfurt am Main

Subjects
AIDS, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, virus diseases, HIV, Antiretroviral Therapy, Highly Active, Viral load, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Cohort analysis, AIDS-related Opportunistic Infections, Mortality
Abstract

International audience; OBJECTIVE: To determine whether differences in short-term virologic failure among commonly used antiretroviral therapy (ART) regimens translate to differences in clinical events in antiretroviral-na? patients initiating ART. DESIGN: Observational cohort study of patients initiating ART between January 2000 and December 2005. SETTING: The Antiretroviral Therapy Cohort Collaboration (ART-CC) is a collaboration of 15 HIV cohort studies from Canada, Europe, and the United States. STUDY PARTICIPANTS: A total of 13 546 antiretroviral-na? HIV-positive patients initiating ART with efavirenz, nevirapine, lopinavir/ritonavir, nelfinavir, or abacavir as third drugs in combination with a zidovudine and lamivudine nucleoside reverse transcriptase inhibitor backbone. MAIN OUTCOME MEASURES: Short-term (24-week) virologic failure (>500 copies/ml) and clinical events within 2 years of ART initiation (incident AIDS-defining event, death, and a composite measure of these two outcomes). RESULTS: Compared with efavirenz as initial third drug, short-term virologic failure was more common with all other third drugs evaluated; nevirapine (adjusted odds ratio = 1.87, 95% confidence interval (CI) = 1.58-2.22), lopinavir/ritonavir (1.32, 95% CI = 1.12-1.57), nelfinavir (3.20, 95% CI = 2.74-3.74), and abacavir (2.13, 95% CI = 1.82-2.50). However, the rate of clinical events within 2 years of ART initiation appeared higher only with nevirapine (adjusted hazard ratio for composite outcome measure 1.27, 95% CI = 1.04-1.56) and abacavir (1.22, 95% CI = 1.00-1.48). CONCLUSION: Among antiretroviral-na? patients initiating therapy, between-ART regimen, differences in short-term virologic failure do not necessarily translate to differences in clinical outcomes. Our results should be interpreted with caution because of the possibility of residual confounding by indication.

Published
2008
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4. Heterogeneity in outcomes of treated HIV-positive patients in Europe and North America: relation with patient and cohort characteristics

Author

Consuelo Viladés, Jörg Janne Vehreschild, Federico Pulido, Michael Ohl, INMA JARRIN, Roberto CAUDA, VICTORIA HERNANDO, Mar Masiá, Aba Mahamat, Clifford Leen, Giuseppe Ippolito, Dominique Costagliola, Margaret May, CARLO FEDERICO PERNO, Vicente Soriano, Montserrat Vargas Laguna, Gianpiero Tebano, Linos Vandekerckhove, Michael John Gill, Fiona Lampe, José A. Oteo, Jane Simoni, Daniela Segala, Jonathan Sterne, Matti Ristola, Antonella D'Arminio Monforte, Lars Østergaard, Alexandra Montoliu, Willem Melchers, Lise Cuzin, Sophie Matheron, André Cabié, Terese L Katzenstein, Paz Sobrino-Vegas, Cedric Arvieux, Bart Rijnders, Elisa De Lazzari, Juan Berenguer, Mª Jesus Perez Elias, Carmen Cabellos, ANDREA COSTANTINI, Robert Hogg, Felipe García, University of Zurich, May, Margaret T, May, Margaret T., Hogg, Robert S., Justice, Amy C., Shepherd, Bryan E., Costagliola, Dominique, Ledergerber, Bruno, Thiã©baut, Rodolphe, John Gill, M., Kirk, Ole, Van Sighem, Ard, Saag, Michael S., Navarro, Gemma, Sobrino vegas, Paz, Lampe, Fiona, Ingle, Suzanne, Guest, Jodie L., Crane, Heidi M., D'Arminio, Monforte Antonella, Vehreschild, Jã¶rg J., Sterne, Jonathan A. C., Art_cc, Castagna, Antonella, Epidémiologie, stratégies thérapeutiques et virologie cliniques dans l'infection à VIH, Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Epidémiologie et Biostatistique [Bordeaux], Université Bordeaux Segalen - Bordeaux 2-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), Population Sciences, University College of London [London] (UCL), Institut de recherche en santé, environnement et travail (Irset), Université d'Angers (UA)-Université de Rennes (UR)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Antiretroviral Therapy Cohort Collaboration (ART-CC), May, M, Hogg, R, Justice, A, Shepherd, B, Costagliola, D, Ledergerber, B, Thiébaut, R, John Gill, M, Kirk, O, van Sighem, A, Saag, M, Navarro, G, Sobrino Vegas, P, Lampe, F, Ingle, S, Guest, J, Crane, H, D'Arminio, M, Vehreschild, J, Sterne, J, Gori, A, Université d'Angers (UA)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Ciències Mèdiques Bàsiques, Universitat Rovira i Virgili., Other departments, Amsterdam institute for Infection and Immunity, Infectious diseases, Graduate School, Amsterdam Public Health, General Internal Medicine, Global Health, Center of Experimental and Molecular Medicine, Paediatric Infectious Diseases / Rheumatology / Immunology, Medical Microbiology and Infection Prevention, and Microbes in Health and Disease (MHD)

Subjects
Male, MESH: CD4 Lymphocyte Count, Epidemiology, HIV Infections, Sex Factor, Other Original Articles, 10234 Clinic for Infectious Diseases, 0302 clinical medicine, MESH: Risk Factors, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Risk Factors, HIV Seropositivity, prognostic model, Age Factor, HIV Infection, 030212 general & internal medicine, Young adult, MESH: Aged, 0303 health sciences, MESH: Middle Aged, Mortality rate, Medicine (all), Socio-economic statu, Age Factors, Cohort, General Medicine, cohort, MESH: HIV Infections, Middle Aged, Prognosis, 3. Good health, Antiretroviral therapy, AIDS, Europe, Anti-Retroviral Agents, MESH: Young Adult, Female, Human, Adult, medicine.medical_specialty, Adolescent, Prognosi, Heterogeneity, HIV, Mortality, Prognostic model, Socio-economic status, socio-economic status, antiretroviral therapy, MEDLINE, 610 Medicine & health, MESH: Anti-Retroviral Agents, MESH: Prognosis, NO, 03 medical and health sciences, Young Adult, MESH: HIV Seropositivity, Sex Factors, Acquired immunodeficiency syndrome (AIDS), MESH: Sex Factors, medicine, Humans, Socioeconomic status, Aged, MESH: Acquired Immunodeficiency Syndrome, MESH: Adolescent, MESH: Age Factors, Acquired Immunodeficiency Syndrome, MESH: Humans, 030306 microbiology, business.industry, Risk Factor, MESH: Adult, Acquired Immunodeficiency Syndrome/drug therapy/mortality, Anti-Retroviral Agents/ therapeutic use, CD4 Lymphocyte Count, Europe/epidemiology, HIV Infections/diagnosis/ drug therapy/ mortality, HIV Seropositivity/drug therapy/mortality, North America/epidemiology, Sex Factors Young Adult, medicine.disease, mortality, Confidence interval, MESH: Male, MESH: North America, Immunology, North America, Anti-Retroviral Agent, MESH: Europe, heterogeneity, business, MESH: Female, Demography, 2713 Epidemiology
Abstract

Background: HIV cohort collaborations, which pool data from diverse patient cohorts, have provided key insights into outcomes of antiretroviral therapy (ART). However, the extent of, and reasons for, between-cohort heterogeneity in rates of AIDS and mortality are unclear. Methods: We obtained data on adult HIV-positive patients who started ART from 1998 without a previous AIDS diagnosis from 17 cohorts in North America and Europe. Patients were followed up from 1 month to 2 years after starting ART. We examined between-cohort heterogeneity in crude and adjusted (age, sex, HIV transmission risk, year, CD4 count and HIV-1 RNA at start of ART) rates of AIDS and mortality using random-effects meta-analysis and meta-regression. Results: During 61 520 person-years, 754/38 706 (1.9%) patients died and 1890 (4.9%) progressed to AIDS. Between-cohort variance in mortality rates was reduced from 0.84 to 0.24 (0.73 to 0.28 for AIDS rates) after adjustment for patient characteristics. Adjusted mortality rates were inversely associated with cohorts' estimated completeness of death ascertainment [excellent: 96-100%, good: 90-95%, average: 75-89%; mortality rate ratio 0.66 (95% confidence interval 0.46-0.94) per category]. Mortality rate ratios comparing Europe with North America were 0.42 (0.31-0.57) before and 0.47 (0.30-0.73) after adjusting for completeness of ascertainment. Conclusions: Heterogeneity between settings in outcomes of HIV treatment has implications for collaborative analyses, policy and clinical care. Estimated mortality rates may require adjustment for completeness of ascertainment. Higher mortality rate in North American, compared with European, cohorts was not fully explained by completeness of ascertainment and may be because of the inclusion of more socially marginalized patients with higher mortality risk. © The Author 2012; all rights reserved.

Published
2012
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