The risk of AIDS-defining events is decreasing over time in the German HIV-1 Seroconverter Cohort

Abstract

BackgroundWith ageing of the HIV-infected population, long-term exposure to treatment, varying adherence, emerging resistance and complications to therapies, effectiveness of Highly Active Antiretroviral Therapy (HAART) needs to be monitored continuously at the population level. The German HIV-1 Seroconverter Cohort is a multi-centre, open, long-term observational cohort including patients with a known or reliably estimated date of HIV-infection i.e. last negative and first positive HIV antibody test within a maximum three-year interval or laboratory evidence of seroconversion. Our study aims to investigate survival improvements and changes in AIDS risk over calendar periods in the German HIV-1 Seroconverter Cohort.MethodsRetrospective (for the pre-1997 period) and prospective (since 1997) data from the German HIV-1 Seroconverter Cohort were used. Time from seroconversion to first AIDS-defining event over calendar periods was analysed by using Cox models adjusting for age at seroconversion, sex, transmission groups and short HIV test interval. Kaplan-Meier methods were used to determine expected survival (remaining AIDS-free) by calendar period.Results2162 seroconverters with 8976 person-years of observation were included in our analysis (up to 31.12.2010). A total of 196 first AIDSdefining events were reported. Two periods i.e. 19972000 and 2007-2010 were statistically associated with a reduction in the risk of AIDS, accounting for an overall reduction of 80%. Compared to1997-2000, hazard ratios were 2.6 (95%CI, 1.6-4.8; p=0.000) in pre-1997 and 0.5 (95%CI, 0.3-0.8; p=0.007) in 20072010. Independent risk factor for AIDS progression was age at seroconversion (HR, 1.3 per 10year-increase; p=0.001).ConclusionHAART effectiveness has improved in the German HIV-1-Seroconverter Cohort. The risk to develop AIDS decreased significantly in 19972000 and in 20072010. However, elderly may require particular monitoring in view of their faster progression to AIDS.

AIDS in the era of antiretroviral therapy: Changes in incidence rates and predictors of AIDS among people living with HIV under clinical care in Germany, a cohort study 1999–2018

“…Our main findings with regard to the IRs are consistent with other studies in the Western European and North American context, which showed that the rates of AIDS‐defining opportunistic infections among people living with HIV have continuously declined since the advent of effective ART [23–25]. As we observed this decline over the course of both follow‐up and calendar periods, our findings also build on existing evidence that the decreasing rates can be attributed to both consistent clinical supervision and improved ART regimens, together with adapted guidelines recommending earlier treatment [26–29].…”

“…When comparing IRs between transmission groups, our analyses of the unadjusted rates showed that PWID had a slower and less pronounced decline over the entire course of clinical care, and PHPC who enrolled in the latest calendar period had substantially higher rates during their first years than those in the other groups. The higher rates among PWID could be related to poorer therapy access and adherence as well as generally worse health conditions among people in this group, which has also been reported by previous studies [29–32]. Similarly, it was found that PHPC are more often diagnosed in advanced stages and also present with higher rates of comorbid illnesses [33, 34], potentially resulting from obstacles such as limited access to healthcare and socioeconomic challenges, rendering PHPC more vulnerable to disease progression [35].…”

Tuberculosis among people living with HIV/AIDS in the German ClinSurv HIV Cohort: long-term incidence and risk factors

“…For the current analysis, data of patients enrolled in the cohort from January 2001 (introduction of the co-formulation boosted protease inhibitors Lopinavir/Ritonavir in Germany [ 18 ]) through December 2011 were extracted from the central ClinSurv HIV database. Basic demographic characteristics including age, gender and geographic origin are recorded as time-fixed covariates at the time of enrollment.…”

Foamy Virus Vectors for HIV Gene Therapy

“…The current standard of care for HIV infection is highly active antiretroviral therapy (HAART), a treatment strategy that uses cocktails of antiretroviral drugs to control HIV replication and to delay disease progression to AIDS. HAART has greatly improved outcomes for individuals living with HIV [2,3]. It efficiently inhibits viral replication and is highly effective at suppressing viral loads.…”