Temporal changes in ART initiation in adults with high CD4 counts in Latin America: a cohort study

Crabtree-Ramírez, Brenda; Caro‐Vega, Yanink; Belaunzarán-Zamudio, Pablo F.; Shepherd, Bryan E.; Rebeiro, Peter F; Veloso, Valdiléa G.; Cortés, Claudia; Padgett, Denis; Gotuzzo, Eduardo; Sierra‐Madero, Juan; McGowan, Catherine C.; Person, Anna K.

doi:10.1002/jia2.25413

Cited by 4 publications

(4 citation statements)

References 21 publications

(21 reference statements)

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“…This may be ascribed to increased knowledge of HIV in MSM, they had more awareness of self-protection. The higher count of the CD4 + T cells at baseline, the lower risk of death, which is consistent with the previous report [ 30 ]. People living with HIV/AIDS who didn't receive ART were at greater risk of death.…”

Section: Discussionsupporting

confidence: 93%

Survival times of HIV/AIDS in different AIDS Diagnostic and Treatment Guidelines from 2006 to 2020 in Liuzhou, China

Ke,

Fang,

Lan

et al. 2023

BMC Public Health

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Background To compare the survival rates of four timing of treatment initiation for people living with HIV/AIDS provided in China in 2006, 2011, 2015, and 2018, and to investigate the factors impacting survival time. Methods A people living with HIV/AIDS retrospective cohort study was in Liuzhou City from April 2006 to December 2020. The information was obtained from the National Comprehensive AIDS Prevention and Control Information System. Life tables and the Kaplan–Meier method were used to calculate participant survival rates and time. The univariate and multivariate Cox regression models were used to investigate the factors related to survival. Results 18,543 participants were included in this study. In four periods, the 1-year survival rates were 81%, 87%, 95%, and 95%. The 2-year survival rates were 76%, 85%, 93%, and 94%. The 3-year survival rates were 73%, 84%, 92%, and 94%. Results of multivariate Cox regression showed that sex, age of HIV diagnosis, ethnicity, household registration, occupation, marital status, the timing of treatment, education level, route of HIV transmission, whether receiving antiretroviral therapy (ART), and the count of CD4+T cells at baseline (count of CD4+T cells at HIV diagnosis) were factors that are significantly correlated with mortality caused by HIV infection. Conclusions With the Guidelines updated from 2006 to 2020, the 1-, 2-, and 3-year survival rates of people living with HIV/AIDS in four periods tended to increase. The timing of treatment initiation of the updated edition of the AIDS Diagnostic and Treatment Guidelines (Guidelines) significantly prolonged the survival time of people living with HIV/AIDS.

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Section: Discussionsupporting

confidence: 93%

Survival times of HIV/AIDS in different AIDS Diagnostic and Treatment Guidelines from 2006 to 2020 in Liuzhou, China

Ke,

Fang,

Lan

et al. 2023

BMC Public Health

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“…We think that the following factors may explain the significant contribution of late ART initiation to TB occurrence: in our cohort, 40% of patients were enrolled prior 2011, and 47% of TB cases, which occurred before ART initiation were enrolled before 2011. Before 2011, there was little evidence of the benefit of ART initiation while on TB treatment [25]; we have documented that time to ART initiation started to decrease up to 2013 in Latin America [26] and up to 2016 in Africa [27], whereas the proportion of late ART initiation is still high after those years, it may be related to a slow in the introduction of the universal ART initiation criteria regardless of CD4 þ cell counts.…”

Section: Discussionmentioning

confidence: 99%

The contribution of late HIV diagnosis on the occurrence of HIV-associated tuberculosis

Girardi

Caro‐Vega

Cozzi‐Lepri

et al. 2022

Aids

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Objectives: To describe the timing of tuberculosis (TB) presentation in relation to diagnosis of HIV infection and antiretroviral therapy (ART) initiation and to evaluate whether the established impact from late presentation to care and late initiation of ART on the risk of TB is retained beyond the observation period of clinical trials. Design:We used marginal structural models to emulate a clinical trial with up to 5 years of follow-up to evaluate the impact of late initiation on TB risk.Methods: People with HIV (PWH) were enrolled from 2007 to 2016 in observational cohorts from Uganda, Peru, Mexico and Italy. The risk of TB was compared in LP (accessing care with CD4 þ cell count 350 cells/ml) vs. nonlate presentation using survival curves and a weighted Cox regression. We emulated two strategies: initiating ART with CD4 þ cell count less than 350 cells/ml vs. CD4 þ cell count at least 350 cells/ml (late initiation). We estimated TB attributable risk and population attributable fraction up to 5 years from the emulated date of randomization.Results: Twenty thousand one hundred and twelve patients and 1936 TB cases were recorded. Over 50% of TB cases were diagnosed at presentation for HIV care. More than 50% of the incident cases of TB after ART initiation were attributable to late presentation; nearly 70% of TB cases during the first year of follow-up could be attributed to late presentation and more than 50%, 5 years after first attending HIV care. Conclusion:Late presentation accounted for a large share of TB cases. Delaying ART initiation was detrimental for incident TB rates, and the impact of late presentation persisted up to 5 years from HIV care entry.

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“…Finally, our population of PLWHIV can be considered characteristic of a population of subjects in outpatient care. Our cohort has an acceptable rate of antiretroviral treatment ( 46 , 47 ). Moreover, in our cohort, the coinfection rate with cytomegalovirus ( 48 ) and hepatitis B ( 49 ) was lower than that in other cohorts, possibly because of differences in HIV transmission routes, age, or geographical differences.…”

Section: Discussionmentioning

confidence: 99%

Aortic Pressure Levels and Waveform Indexes in People Living With Human Immunodeficiency Virus: Impact of Calibration Method on the Differences With Respect to Non-HIV Subjects and Optimal Values

Díaz

Grand

Torrado

et al. 2021

Front. Cardiovasc. Med.

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Background: There are scarce and controversial data on whether human immunodeficiency virus (HIV) infection is associated with changes in aortic pressure (aoBP) and waveform-derived indexes. Moreover, it remains unknown whether potential differences in aoBP and waveform indexes between people living with HIV (PLWHIV) and subjects without HIV (HIV-) would be affected by the calibration method of the pressure waveform.Aims: To determine: (i) whether PLWHIV present differences in aoBP and waveform-derived indexes compared to HIV- subjects; (ii) the relative impact of both HIV infection and cardiovascular risk factors (CRFs) on aoBP and waveform-derived indexes; (iii) whether the results of the first and second aims are affected by the calibration method.Methods: Three groups were included: (i) PLWHIV (n = 86), (ii) HIV- subjects (general population; n = 1,000) and (iii) a Reference Group (healthy, non-exposed to CRFs; n = 398). Haemodynamic parameters, brachial pressure (baBP; systolic: baSBP; diastolic: baDBP; mean oscillometric: baMBPosc) and aoBP and waveform-derived indexes were obtained. Brachial mean calculated (baMBPcalc=baDBP+[baSBP-baDBP]/3) pressure was quantified. Three waveform calibration schemes were used: systolic-diastolic, calculated (baMBPcalc/baDBP) and oscillometric mean (baMBPosc/baDBP).Results: Regardless of CRFs and baBP, PLWHIV presented a tendency of having lower aoBP and waveform-derived indexes which clearly reached statistical significance when using the baMBPosc/baDBP or baMBPcalc/baDBP calibration. HIV status exceeded the relative weight of other CRFs as explanatory variables, being the main explanatory variable for variations in central hemodynamics when using the baMBPosc/baDBP, followed by the baMBPcalc/baDBP calibration.Conclusions: The peripheral waveform calibration approach is an important determinant to reveal differences in central hemodynamics in PLWHIV.

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Temporal changes in ART initiation in adults with high CD4 counts in Latin America: a cohort study

Cited by 4 publications

References 21 publications

Survival times of HIV/AIDS in different AIDS Diagnostic and Treatment Guidelines from 2006 to 2020 in Liuzhou, China

Survival times of HIV/AIDS in different AIDS Diagnostic and Treatment Guidelines from 2006 to 2020 in Liuzhou, China

The contribution of late HIV diagnosis on the occurrence of HIV-associated tuberculosis

Aortic Pressure Levels and Waveform Indexes in People Living With Human Immunodeficiency Virus: Impact of Calibration Method on the Differences With Respect to Non-HIV Subjects and Optimal Values

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