Health care for people living with HIV has improved substantially in the past two decades. Robust estimates of how these improvements have affected prognosis and life expectancy are of utmost ...importance to patients, clinicians, and health-care planners. We examined changes in 3 year survival and life expectancy of patients starting combination antiretroviral therapy (ART) between 1996 and 2013.
We analysed data from 18 European and North American HIV-1 cohorts. Patients (aged ≥16 years) were eligible for this analysis if they had started ART with three or more drugs between 1996 and 2010 and had at least 3 years of potential follow-up. We estimated adjusted (for age, sex, AIDS, risk group, CD4 cell count, and HIV-1 RNA at start of ART) all-cause and cause-specific mortality hazard ratios (HRs) for the first year after ART initiation and the second and third years after ART initiation in four calendar periods (1996–99, 2000–03 comparator, 2004–07, 2008–10). We estimated life expectancy by calendar period of initiation of ART.
88 504 patients were included in our analyses, of whom 2106 died during the first year of ART and 2302 died during the second or third year of ART. Patients starting ART in 2008–10 had lower all-cause mortality in the first year after ART initiation than did patients starting ART in 2000–03 (adjusted HR 0·71, 95% CI 0·61–0·83). All-cause mortality in the second and third years after initiation of ART was also lower in patients who started ART in 2008–10 than in those who started in 2000–03 (0·57, 0·49–0·67); this decrease was not fully explained by viral load and CD4 cell count at 1 year. Rates of non-AIDS deaths were lower in patients who started ART in 2008–10 (vs 2000–03) in the first year (0·48, 0·34–0·67) and second and third years (0·29, 0·21–0·40) after initiation of ART. Between 1996 and 2010, life expectancy in 20-year-old patients starting ART increased by about 9 years in women and 10 years in men.
Even in the late ART era, survival during the first 3 years of ART continues to improve, which probably reflects transition to less toxic antiretroviral drugs, improved adherence, prophylactic measures, and management of comorbidity. Prognostic models and life expectancy estimates should be updated to account for these improvements.
UK Medical Research Council, UK Department for International Development, EU EDCTP2 programme.
Incidence and Risk Factors for New-Onset Diabetes in HIV-Infected Patients
The Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) Study
Stephane De Wit , MD, PHD 1 ,
Caroline A. Sabin , PHD ...2 ,
Rainer Weber , MD 3 ,
Signe Westring Worm , MD 4 ,
Peter Reiss , MD, PHD 5 ,
Charles Cazanave , MD 6 ,
Wafaa El-Sadr , MD, MPH 7 ,
Antonella d'Arminio Monforte , MD, DMSC 8 ,
Eric Fontas , MD 9 ,
Matthew G. Law , PHD 10 ,
Nina Friis-Møller , MD, PHD 4 and
Andrew Phillips , PHD 2
1 Centre Hospitalier Universitaire Saint-Pierre, Brussels, Belgium
2 Royal Free and University College, London, U.K
3 University Hospital Zurich, Zurich, Switzerland
4 University of Copenhagen, Copenhagen, Denmark
5 Academic Medical Center, Amsterdam, the Netherlands
6 Bordeaux 2 University, Bordeaux, France
7 Columbia University, Harlem Hospital, New York, New York
8 University of Milan, Milan, Italy
9 Centre Hospitalier Universitaire Nice, Hôpital de l'Archet, Nice, France
10 National Centre in HIV Epidemiology and Clinical Research, Sydney, Australia
Corresponding author: Stéphane De Wit, MD, PhD, Department of Infectious Diseases, St. Pierre University Hospital, 322, rue
Haute, B-1000 Brussels, Belgium. E-mail: stephane_dewit{at}stpierre-bru.be
Abstract
OBJECTIVE —The aims of this study were to determine the incidence of diabetes among HIV-infected patients in the Data Collection on
Adverse Events of Anti-HIV Drugs (D:A:D) cohort, to identify demographic, HIV-related, and combination antiretroviral therapy
(cART)-related factors associated with the onset of diabetes, and to identify possible mechanisms for any relationships found.
RESEARCH DESIGN AND METHODS —D:A:D is a prospective observational study of 33,389 HIV-infected patients; diabetes is a study end point. Poisson regression
models were used to assess the relation between diabetes and exposure to cART after adjusting for known risk factors for diabetes,
CD4 count, lipids, and lipodystrophy.
RESULTS —Over 130,151 person-years of follow-up (PYFU), diabetes was diagnosed in 744 patients (incidence rate of 5.72 per 1,000 PYFU
95% CI 5.31–6.13). The incidence of diabetes increased with cumulative exposure to cART, an association that remained significant
after adjustment for potential risk factors for diabetes. The strongest relationship with diabetes was exposure to stavudine;
exposures to zidovudine and didanosine were also associated with an increased risk of diabetes. Time-updated measurements
of total cholesterol, HDL cholesterol, and triglycerides were all associated with diabetes. Adjusting for each of these variables
separately reduced the relationship between cART and diabetes slightly. Although lipodystrophy was significantly associated
with diabetes, adjustment for this did not modify the relationship between cART and diabetes.
CONCLUSION —Stavudine and zidovudine are significantly associated with diabetes after adjustment for risk factors for diabetes and lipids.
Adjustment for lipodystrophy did not modify the relationship, suggesting that the two thymidine analogs probably directly
contribute to insulin resistance, potentially through mitochondrial toxicity.
cART, combination antiretroviral therapy
CVD, cardiovascular disease
D:A:D, Data Collection on Adverse Events of Anti-HIV Drugs
MACS, Multicenter AIDS Cohort Study
NNRTI, nonnucleoside reverse transcriptase inhibitor
NRTI, nucleoside reverse transcriptase inhibitor
PYFU, person-years of follow-up
RR, relative risk
Footnotes
Published ahead of print at http://care.diabetesjournals.org on 11 February 2008. DOI: 10.2337/dc07-2013.
Additional information for this article can be found in an online appendix at http://dx.doi.org/10.2337/dc07-2013 .
The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore
be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.
See accompanying editorial, p. 1267 .
Accepted February 4, 2008.
Received October 19, 2007.
DIABETES CARE
Noncholera vibriosis is a rare, opportunistic bacterial infection caused by Vibrio spp. other than V. cholerae O1/O139 and diagnosed mainly during the hot summer months in patients after seaside ...activities. Detailed knowledge of circulating pathogenic strains and heterogeneities in infection outcomes and disease dynamics may help in patient management. We conducted a multicenter case-series study documenting Vibrio infections in 67 patients from 8 hospitals in the Bay of Biscay, France, over a 19-year period. Infections were mainly caused by V. alginolyticus (34%), V. parahaemolyticus (30%), non-O1/O139 V. cholerae (15%), and V. vulnificus (10%). Drug-susceptibility testing revealed intermediate and resistant strains to penicillins and first-generation cephalosporins. The acute infections (e.g., those involving digestive disorder, cellulitis, osteitis, pneumonia, and endocarditis) led to a life-threatening event (septic shock), amputation, or death in 36% of patients. Physicians may need to add vibriosis to their list of infections to assess in patients with associated risk factors.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, ODKLJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Abstract
We evaluated people living with Human Immunodeficiency Virus’ (PLWH) quality of life (QoL) and assessed whether their demographic, disease-related, socioeconomic, or behavioral ...characteristics were associated with poorer QoL. ANRS CO3 AQUIVIH-NA cohort participants (Nouvelle Aquitaine, France) were recruited to a cross-sectional study (2018–2020) and their QoL assessed (WHOQOL-BREF). We calculated median (Q1, Q3) QoL domain scores and assessed factors associated with poorer median QoL using bivariable and multivariable quartile regression. Of the 965 PLWH included, 98.4% were on antiretroviral therapy, 94.7% were virally-suppressed, 63.5% reported good/very good QoL. Median scores (0–100) were highest for physical (69;Q1, Q3: 56, 81) and environmental (69; 56, 75) QoL and lowest for social (56; 44, 69) and psychological (56; 44, 69) QoL. PLWH with ≥ 3 comorbidities, HIV-related stigma, or income of < 1500€/month had poorer median adjusted physical, psychological, social, and environmental QoL scores compared to reference groups. While more than half of PLWH reported good/very good QoL, we have not achieved good QoL in 90% of PLWH. Multi-morbidity, HIV-related stigma, and social determinants were consistently and independently associated with poorer QoL. Addressing structural factors in addition to those indirectly related to HIV is required to attain good QoL in all PLWH.
To estimate mortality rates and prognostic factors in HIV-positive patients who started combination antiretroviral therapy between 1996-1999 and survived for more than ten years.
We used data from 18 ...European and North American HIV cohort studies contributing to the Antiretroviral Therapy Cohort Collaboration. We followed up patients from ten years after start of combination antiretroviral therapy. We estimated overall and cause-specific mortality rate ratios for age, sex, transmission through injection drug use, AIDS, CD4 count and HIV-1 RNA.
During 50,593 person years 656/13,011 (5%) patients died. Older age, male sex, injecting drug use transmission, AIDS, and low CD4 count and detectable viral replication ten years after starting combination antiretroviral therapy were associated with higher subsequent mortality. CD4 count at ART start did not predict mortality in models adjusted for patient characteristics ten years after start of antiretroviral therapy. The most frequent causes of death (among 340 classified) were non-AIDS cancer, AIDS, cardiovascular, and liver-related disease. Older age was strongly associated with cardiovascular mortality, injecting drug use transmission with non-AIDS infection and liver-related mortality, and low CD4 and detectable viral replication ten years after starting antiretroviral therapy with AIDS mortality. Five-year mortality risk was <5% in 60% of all patients, and in 30% of those aged over 60 years.
Viral replication, lower CD4 count, prior AIDS, and transmission via injecting drug use continue to predict higher all-cause and AIDS-related mortality in patients treated with combination antiretroviral therapy for over a decade. Deaths from AIDS and non-AIDS infection are less frequent than deaths from other non-AIDS causes.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
We report 5 cases of vascular Q fever complicated by polymicrobial superinfection in patients who had no risk factors for acute Q fever. Q fever was diagnosed by serologic and molecular assays for ...Coxiella burnetii. We confirmed additional infections using conventional graft cultures.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, ODKLJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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