Survival following HIV infection of a cohort followed up from seroconversion in the UK

Ewings, Fiona M.; Bhaskaran, Krishnan; McLean, Ken; Hawkins, David; Fisher, Martin; Fidler, Sarah; Gilson, Richard; Nock, Demelza; Brettle, R P; Johnson, Margaret; Phillips, Andrew; Porter, Kholoud

doi:10.1097/qad.0b013e3282f3915e

Cited by 44 publications

(34 citation statements)

References 16 publications

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“…[71][72][73][74][75][76][77] Interestingly, this finding is not explained by differences in virological response, as older HIV-infected patients tend to have a superior virological outcome when compared with younger patients. [78][79][80][81][82][83] Some suggests that these finding may be linked with higher adherence in older patients, 78,[84][85] but other authors reported a higher risk of inadequate adherence in HIV patients who have other comorbidities and take other medications besides HAART.…”

Section: Clinical Outcomementioning

confidence: 95%

Immunosenescence and hurdles in the clinical management of older HIV-patients

2017

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People living with HIV (PLWH) who are treated with effective highly active antiretroviral therapy (HAART) have a similar life expectancy to the general population. Moreover, an increasing proportion of new HIV diagnoses are made in people older than 50 y. The number of older HIVinfected patients is thus constantly growing and it is expected that by 2030 around 70% of PLWH will be more than 50 y old. On the other hand, HIV infection itself is responsible for accelerated immunosenescence, a progressive decline of immune system function in both the adaptive and the innate arm, which impairs the ability of an individual to respond to infections and to give rise to long-term immunity; furthermore, older patients tend to have a worse immunological response to HAART.In this review we focus on the pathogenesis of HIV-induced immunosenescence and on the clinical management of older HIV-infected patients.

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Section: Clinical Outcomementioning

confidence: 95%

Immunosenescence and hurdles in the clinical management of older HIV-patients

2017

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“…Other factors, which were not assessed in our current study but may contribute to inferior virological outcome, may include poverty [38], lack of family support [39], alcohol use [37], smoking, depression [40,41], and psychiatric comorbidity [42]. Virological failure and failure of addiction treatment programmes among HIV-infected IDUs result in increased morbidity and mortality [19,31,[42][43][44][45].…”

Section: Discussionmentioning

confidence: 99%

Uptake of and virological response to antiretroviral therapy among HIV‐infected former and current injecting drug users and persons in an opiate substitution treatment programme: the Swiss HIV Cohort Study

et al. 2009

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ObjectivesThe aim of the study was to investigate the influence of continued injecting drug use, enrolment in an opiate substitution treatment programme (OSTP), or cessation of injecting drug use on the uptake and course of antiretroviral therapy (ART). DesignA prospective observational study of all participants in the Swiss HIV Cohort Study followed between 1997 and 2006 was carried out. MethodsWe distinguished four groups of former or current injecting drug users (IDUs): (i) abstinent former IDUs; (ii) persons in OSTPs without concomitant injecting drug use; (iii) persons in OSTPs with concomitant injecting drug use; (vi) current IDUs. These groups were compared with a group of patients who had never been IDUs. Factors related to ART uptake and virological endpoints were analysed using logistic generalized estimating equations. ResultsWe followed 8660 participants for 48 477 person-years; 29.7% were in the IDU HIV transmission group. The likelihood of being on ART at biannual visits was lower among individuals in OSTPs with concomitant injecting drug use [odds ratio (OR) 0.79; 95% confidence interval (CI) 0.71-0.89] and current IDUs (OR 0.80; 95% CI 0.67-0.96), compared with those who had never been IDUs (reference), abstinent former IDUs (OR 1.13; 95% CI 1.02-1.25) and individuals in OSTPs without injecting drug use (OR 1.18; 95% CI 1.06-1.31). The likelihood of suppressed viral replication on ART was similar among those who had never been IDUs, abstinent former IDUs and individuals in an OSTP without injecting drug use, and lower among those in OSTPs with concomitant drug use (OR 0.82; 95% CI 0.72-0.93) and current IDUs (OR 0.81; 0.65-1.00). Adherence to ART was decreased among persons with continued injecting drug use, and correlated with virological outcome. [4][5][6][7], the potential for interactions among medication, opiate substitution and illicit drugs [8], adverse effects [9], and limited access to [10,11], delayed use of [10,12,13], and decreased response to treatment [4,7]. As a consequence of such difficulties, physicians may be reluctant to offer ART to HIV-infected IDUs [14,15], resulting in less than optimal care and worse outcome [16,17].In HIV research, the term 'IDU' is commonly used to describe the HIV transmission category or patient characteristics. When investigating the course of HIV infection and the outcome of ART in these patients, however, it is an oversimplification to consider IDUs as a homogenous group. IDUs frequently change their drug injection behaviour, drug addiction treatment status or health care setting [18,19]. We aimed to investigate the influence of injecting drug use behaviour and enrolment in opiate substitution treatment programmes on the uptake of and virological response to ART among persons classified as belonging to the IDU HIV transmission group, and to study the association between injecting drug use behaviour and adherence to ART. We distinguished four distinct groups of former or current IDUs: (i) abstinent former IDUs who had completely stopped injecting d...

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“…Mortality rates among people living with HIV/AIDS (PLWHA) remain higher than those observed in the general population [1], despite the significant decline observed after the large-scale implementation of antiretroviral therapy (ARV) [2,3]. The concern goes beyond the early death of the patient, even in developing countries, and has been focusing on the adverse effects of ARV and comorbidities not related to HIV.…”

Section: Introductionmentioning

confidence: 99%

“…Vulnerability increases depending on lifestyle and risk behaviors such as smoking, alcoholism, and illicit drug use, as well as obesity [4]. As the mortality rate among PLWHA remains higher in comparison with the general population [1], further efforts are needed to identify and reduce the prevalence of risk factors associated with AIDSrelated mortality as well as mortality not related to AIDS. The latter is responsible for half of the deaths in some countries [5].…”

Section: Introductionmentioning

confidence: 99%

Comparison between potential risk factors for cardiovascular disease in people living with HIV/AIDS in areas of Brazil

Ximenes

Lacerda

Miranda-Filho

et al. 2015

J Infect Dev Ctries

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Introduction: Coronary heart disease and its risk factors depend on genetic characteristics, behaviors, and habits, all of which vary in different regions. The use of antiretroviral therapy (ARV) has increased the survival of people living with HIV/AIDS (PLWHA), who begin to present mortality indicators similar to the general population. This study aimed to compare the prevalence of factors potentially associated with coronary heart disease in three cohorts of PLWHA from three different regions of Brazil. Methodology: The study population was composed of participants of the cohorts of Pernambuco, Goiás, and Rio Grande do Sul states. In these sites, adult patients attending reference centers for treatment of HIV/AIDS were consecutively enrolled. Results: Pernambuco and Goiás had a higher proportion of males and of individuals with high-risk high-density lipoprotein (HDL). Pernambuco also had a greater proportion of individuals with hypertension, elevated triglycerides, and CD4 counts below 200 cells/mm 3 . Lower education was more frequent in Rio Grande do Sul, and the use of cocaine was higher in this state. Conclusions: The results confirm the importance of risk factors for coronary heart disease in PLHIV and highlight differences in the three cohorts. Specific measures against smoking and sedentary lifestyle, avoidance of advanced stages of immunosuppression, and appropriate treatment of dyslipidemia and dysglicemia are urgently needed to cope with the disease in Brazil.

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Survival following HIV infection of a cohort followed up from seroconversion in the UK

Cited by 44 publications

References 16 publications

Immunosenescence and hurdles in the clinical management of older HIV-patients

Immunosenescence and hurdles in the clinical management of older HIV-patients

Uptake of and virological response to antiretroviral therapy among HIV‐infected former and current injecting drug users and persons in an opiate substitution treatment programme: the Swiss HIV Cohort Study

Comparison between potential risk factors for cardiovascular disease in people living with HIV/AIDS in areas of Brazil

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