Estimated life expectancy gains with antiretroviral therapy among adults with HIV in Latin America and the Caribbean: a multisite retrospective cohort study

Smiley, Casey L; Rebeiro, Peter F; César, Carina; Belaunzarán-Zamudio, Pablo F; Crabtree-Ramírez, Brenda; Padgett, Denis; Gotuzzo, Eduardo; Cortés, Claudia; Pape, Jean William; Veloso, Valdiléa G.; McGowan, Catherine C.; Castilho, Jessica L; Caribbean, Central

doi:10.1016/s2352-3018(20)30358-1

Cited by 37 publications

(39 citation statements)

References 25 publications

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“…The global standard of HIV care is universal access to ART, which has significantly increased life expectancy and decreased mortality and morbidity caused by HIV. 12 , 13 The Treatment as Prevention (TasP) model, which now informs HIV prevention strategies worldwide, suggests that achieving high rates of viral suppression by scaling up access and adherence to ART among PWH may significantly reduce future transmission, since undetectable means untransmissible (U = U). 14 The potential success of the TasP framework relies on individual patients achieving and sustaining viral suppression through adequate adherence to ART and consistent engagement in HIV care.…”

Section: Discussionmentioning

confidence: 99%

Evaluating Barriers to Viral Suppression among People with HIV in Santiago, Dominican Republic

McCarthy

Tao

Lerebours

et al. 2022

J Int Assoc Provid AIDS Care

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The Dominican Republic (DR) has the second-highest prevalence of HIV infection in the Caribbean, but viral suppression and treatment adherence are not well understood. We conducted a cross-sectional study among people living with HIV/AIDS(PLWHA) to fill in the knowledge gap. Questionnaire was used to collect demographic data, antiretroviral therapy (ART) adherence, and barriers and facilitators to HIV care. Viral load and other clinical information were extracted through chart reviews. Descriptive analyzes and logistic regression were conducted to explore factors associated with non-viral suppression and imperfect ART adherence. Of 193 PLWHA 83.9% were virally suppressed. Those that were non-virally suppressed were more likely of being male (odds ratio [OR]: 2.55, 95% confidence interval [CI]: 1.17-5.58) and less likely of being unemployed (OR: 0.28, 95% CI: 0.08-0.96). However, being male (OR: 0.78, 95% CI:0.40-1.53) and unemployed (OR: 0.28, 95% CI:0. 08-1.21) were less likely to report imperfect adherence. Tailored interventions are needed to improve adherence and viral suppression in DR.

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Section: Discussionmentioning

confidence: 99%

Evaluating Barriers to Viral Suppression among People with HIV in Santiago, Dominican Republic

McCarthy

Tao

Lerebours

et al. 2022

J Int Assoc Provid AIDS Care

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“…With the continuous development of ART, HIV infection has changed from a deadly disease to a chronic long-term disease. Although AIDS cannot be cured at present, ART can significantly reduce the viral loads, maintain patients’ immune function, and prolong life expectancy ( Antiretroviral Therapy Cohort Collaboration, 2017 ; Wu, 2016 ; Marcus et al, 2000 ; GBD 2019 HIV Collaborators, 2021 ; Smiley et al, 2021 ). In recent years, the role of NNRTIs in ART has been weakened to some extent with the emergence of more and more tolerated antiretroviral drugs and regimens.…”

Section: Discussionmentioning

confidence: 99%

“…HIV-1, a HIV subtype is the main driver of the global AIDS pandemic. Studies have shown that antiretroviral therapy (ART) has significantly reduced the rates of HIV-1-induced, AIDS-related, morbidity and mortality, and the life expectancy of HIV-1-infected people is nearing that of the general population ( Antiretroviral Therapy Cohort Collaboration, 2017 ; Wu, 2016 ; Marcus et al, 2000 ; GBD 2019 HIV Collaborators, 2021 ; Smiley et al, 2021 ). Regimens for initiating antiretroviral therapy in HIV-infected people are usually comprised of two nucleoside reverse transcriptase inhibitors as backbone drugs, combined with a third core drug.…”

Section: Introductionmentioning

confidence: 99%

“…Two phase 3 clinical trials (DRIVE-AHEAD, DRIVE-FORWARD), have compared DOR + TDF+3TC/emtricitabine (FTC) with efavirenz (EFV)- or darunavir (DRV)-based regimens in treatment-naïve, HIV-1-positive patients ( Molina et al, 2018 ; Orkin et al, 2019 ) and found that it is efficacious, safe and tolerable. Since the emergence of ART, the survival rate of HIV- infected people has improved significantly, turning HIV infection into a controllable chronic disease ( Antiretroviral Therapy Cohort Collaboration, 2017 ; Wu, 2016 ; Marcus et al, 2000 ; GBD 2019 HIV Collaborators, 2021 ; Smiley et al, 2021 ). However, PLWH often need to use ART for life, and as their life expectancy increases, so does the amount of time they are on ART.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of the Efficacy and Safety of a Doravirine-Based, Three-Drug Regimen in Treatment-Naïve HIV-1 Positive Adults: A Bayesian Network Meta-Analysis

Zhang

Zhou

et al. 2022

Front. Pharmacol.

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Introduction: Extensive use of antiretroviral therapy has remarkably improved the survival rates of people living with HIV. Doravirine (DOR) is a newly-approved antiretroviral belonging to the class of non-nucleoside reverse transcriptase inhibitors. Here, we compared the efficacy and safety of DOR + tenofovir dipivoxil fumarate (TDF)+Lamivudine (3TC)/Emtritabine (FTC) with traditional triple therapies in treatment-naïve HIV-1-positive adults.Methods: Randomized controlled trials involving treatment-naïve HIV-1-positive adults that met inclusion criteria were systematically retrieved and data on the following outcomes extracted: virological suppression, adverse events, severe adverse events, and drug-related adverse events. A Bayesian network meta-analysis was then performed on the data.Results: This study included a total of 39 randomized controlled trials involving 26 antiretroviral therapies and 21,110 HIV1-positive patients. At week 48, relative to the other 25 regimens included in the network of virological suppression, DOR + TDF+3TC/FTC exhibited superiority to some efavirenz, nevirapine, atazanavir, or lopinavir-based regimens, including efavirenz + abacavir+3TC [Odd Ratio (OR) = 0.52, 95% confidence interval (CrI) = 0.35–0.77]. At week 48, the performance of DOR + TDF+3TC/FTC was relatively similar to all other analyzed regimens in terms of adverse events. The DOR + TDF+3TC/FTC regimen performed better in terms of severe adverse events and drug-related adverse events.Conclusion: The network meta-analysis showed that DOR + TDF+3TC/FTC has good efficacy and safety at 48 weeks.Systematic Review Registration: Open Science Framework, https://osf.io/6ybp7.

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“…Notably however, treat-all policy adoption has occurred at a disproportionate pace across geographical settings and communities. Most high-income countries have made treat-all a national policy, and the life expectancy of their people living with HIV (PLWHIV) have has greatly improved (2,3). In middle and low-income regions such as West Africa, approximately 40% of healthcare sites are still dealing with HIV without this policy (4).…”

Section: Introductionmentioning

confidence: 99%

Rapid Clinical Progression and Its Correlates Among Acute HIV Infected Men Who Have Sex With Men in China： Findings From a 5-Year Multicenter Prospective Cohort Study

et al. 2021

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BackgroundIn the “treat all” era, there are few data on the nature of HIV clinical progression in middle-income countries. The aim of the current study was to prospectively analyze the clinical progression of HIV and its indicators among men in China with acute HIV who have sex with men.MethodsFrom 2009–2014 a total of 400 men with acute HIV infection (AHI) were identified among 7,893 men who have sex with men via periodic pooled nucleic acid amplification testing, and they were assigned to an AHI prospective cohort in Beijing and Shenyang, China. Rapid progression was defined as two consecutive CD4+ T cell counts < 350/µL within 3–24 months post-infection. Kaplan−Meier and Cox-regression analyses were conducted to identify predictors of rapid progression.ResultsAmong 400 men with AHI 46.5% were rapid progressors, 35.1% reached rapid progressor status by 12 months post-infection, and 63.9% reached rapid progressor status by 24 months. Rapid progression was associated with herpes simplex-2 virus coinfection (adjusted hazard ratio [aHR] 1.7, 95% confidence interval [CI] 1.2–2.3], depression (aHR 1.9, 95% CI 1.5–2.6), baseline CD4+ T cell count < 500/μL (aHR 3.5, 95% CI 2.4–5.1), higher baseline HIV viral load (aHR 1.6, 95% CI 1.2–2.3), acute symptoms lasting ≥ 2 weeks (aHR 1.6, 95% CI 1.1–2.2), higher body mass index (aHR 0.9, 95% CI 0.9–1.0), higher HIV viral load (aHR 1.7, 95% CI 1.4–2.1), set point viral load at 3 months (aHR 2.0, 95% CI 1.6–2.5), each 100-cell/μL decrease in CD4+ T cell count at 3 months (aHR 2.2, 95% CI 1.9–2.5), and baseline routine blood tests including white blood cell count < 5.32, hemoglobin ≥ 151, mean corpuscular hemoglobin ≥ 30.5, hemoglobin concentration ≥ 342, mean platelet count ≥ 342, lymphocytes ≥ 1.98, and mixed cell count ≥ 0.4 (all p < 0.05).ConclusionAlmost half of the patients underwent rapid clinical progression within 2 years after HIV infection. A treat-all policy is necessary and should be strengthened globally. Rapid progression was correlated with herpes simplex-2 virus coinfection, depression, low CD4+ T cell counts, and high set point viral load in acute infection stage. Rapid progression can be identified via simple indicators such as body mass index and routine blood test parameters in low and middle-income countries.

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Estimated life expectancy gains with antiretroviral therapy among adults with HIV in Latin America and the Caribbean: a multisite retrospective cohort study

Cited by 37 publications

References 25 publications

Evaluating Barriers to Viral Suppression among People with HIV in Santiago, Dominican Republic

Evaluating Barriers to Viral Suppression among People with HIV in Santiago, Dominican Republic

Comparison of the Efficacy and Safety of a Doravirine-Based, Three-Drug Regimen in Treatment-Naïve HIV-1 Positive Adults: A Bayesian Network Meta-Analysis

Rapid Clinical Progression and Its Correlates Among Acute HIV Infected Men Who Have Sex With Men in China： Findings From a 5-Year Multicenter Prospective Cohort Study

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