Clinical effects of durability of immunosuppression in virologically suppressed ART-initiating persons with HIV in Latin America. A retrospective cohort study

Detalhes bibliográficos
Autor(a) principal: Caro-Vega, Yanink
Data de Publicação: 2022
Outros Autores: Rebeiro, Peter F., Shepherd, Bryan E., Belaunzarán-Zamudio, Pablo F., Crabtree-Ramirez, Brenda, Cesar, Carina, Luz, Paula Mendes, Cortes, Claudia P., Padget, Denis, Gotuzzo, Eduardo, McGowan, Catherine C., Sierra-Madero, Juan G.
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Repositório Institucional da FIOCRUZ (ARCA)
Texto Completo: https://www.arca.fiocruz.br/handle/icict/52905
Resumo: This work was supported by the NIH-funded Caribbean, Central and South America network for HIV epidemiology (CCASAnet, U01AI069923), a member cohort of the International Epidemiologic Databases to Evaluate AIDS (leDEA). This award is funded by the following institutes: Eunice Kennedy Shriver National Institute Of Child Health & Human Development (NICHD), National Cancer Institute (NCI), National Institute Of Allergy And Infectious Diseases (NIAID), National Institute Of Mental Health (NIMH), the National Heart, Lung, and Blood Institute (NHLBI), the National Institute on Alcohol Abuse and Alcoholism (NIAAA), the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), and the Fogarty International Center (FIC). Specific funding was provided from the Fogarty International Center (FIC) for lead author, Yanink Caro-Vega, for the Fogarty-IeDEA Mentorship Program (FIMP).
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spelling Caro-Vega, YaninkRebeiro, Peter F.Shepherd, Bryan E.Belaunzarán-Zamudio, Pablo F.Crabtree-Ramirez, BrendaCesar, CarinaLuz, Paula MendesCortes, Claudia P.Padget, DenisGotuzzo, EduardoMcGowan, Catherine C.Sierra-Madero, Juan G.2022-05-25T23:03:15Z2022-05-25T23:03:15Z2022CARO-VEGA, Yanink et al. Clinical effects of durability of immunosuppression in virologically suppressed ART-initiating persons with HIV in Latin America. A retrospective cohort study. Lancet Regional Health. Americas, v. 8, p. 1-16, 20222667-193Xhttps://www.arca.fiocruz.br/handle/icict/5290510.1016/j.lana.2021.100175This work was supported by the NIH-funded Caribbean, Central and South America network for HIV epidemiology (CCASAnet, U01AI069923), a member cohort of the International Epidemiologic Databases to Evaluate AIDS (leDEA). This award is funded by the following institutes: Eunice Kennedy Shriver National Institute Of Child Health & Human Development (NICHD), National Cancer Institute (NCI), National Institute Of Allergy And Infectious Diseases (NIAID), National Institute Of Mental Health (NIMH), the National Heart, Lung, and Blood Institute (NHLBI), the National Institute on Alcohol Abuse and Alcoholism (NIAAA), the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), and the Fogarty International Center (FIC). Specific funding was provided from the Fogarty International Center (FIC) for lead author, Yanink Caro-Vega, for the Fogarty-IeDEA Mentorship Program (FIMP).Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ). Mexico City, Mexico.Vanderbilt University School of Medicine. Nashville, TN, USA.Vanderbilt University School of Medicine. Nashville, TN, USA.Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ). Mexico City, Mexico.Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ). Mexico City, Mexico.Fundación Huésped. Buenos Aires, Argentina.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil.Fundación Arriarán y Universidad de Chile. Santiago, Chile.Instituto Hondureño de Seguridad Social. Tegucigalpa, Honduras.Universidad Peruana Cayetano Heredia. Lima, Perú.Vanderbilt University School of Medicine. Nashville, TN, USA.Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ). Mexico City, Mexico.Background: Clinical outcomes are rarely studied in virologically suppressed people living with HIV (PWH) and incomplete CD4 recovery. To explore whether time living with severe immunosuppression predict clinical outcomes better than baseline or time updated CD4, we estimated the association between cumulative percentage of time with CD4 <200 cells/μL during viral suppression (VS) (%tCD4<200), and mortality and comorbidities during 2000-2019. Methods: In a retrospective cohort analysis, we followed PWH initiating ART in Latin America from first VS (HIV-RNA<200 copies/μL) to death, virological failure or loss to follow-up. We fit Cox models to estimate risk of death and/or AIDS-defining and serious non-AIDS-defining events (ADE and SNADE -cancer, cardiovascular, liver, and renal diseases) by %tCD4<200 (continuous variable). We predicted survival probabilities for each event and calculated risks of hypothetical cases of different %tCD4<200. Findings: In 8,369 patients with 34·9 months of follow-up (median, IQR: 16·7, 69·1), 4,274 (51%) started ART with CD4<200 cells/μL. Median %tCD4<200 was 0% (IQR: 0, 15%). We identified 195 (2·3%) deaths and 584 (7·2%) patients with ADE/SNADE. For an increased %tCD4<200 of 15% (e.g., 15% vs. 0%), the adjusted relative hazard (aHR) of death was 1·27 (95% confidence interval [CI]: 1·19 - 1·35), of ADE/SNADE was 1·13 (95%CI: 1·09 - 1·17), of SNADE was 0·96 (95%CI: 0·89 - 1·02) and of death/ADE/SNADE was 1·11 (95%CI: 1·07 - 1·14). Estimates were similar after adjusting for time updated CD4 count. Interpretation: In virologically suppressed PWH, increased time living with severe immunosuppression had an increased risk of death and ADE/SNADE in this Latin American cohort, independently of time updated CD4 count.engPublic Library of ScienceClinical effects of durability of immunosuppression in virologically suppressed ART-initiating persons with HIV in Latin America. A retrospective cohort studyinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleAIDS defining and non-AIDS defining eventsHIVLatin AmericaSustained Virologic ResponseCumulative low CD4 countsinfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da FIOCRUZ (ARCA)instname:Fundação Oswaldo Cruz (FIOCRUZ)instacron:FIOCRUZLICENSElicense.txtlicense.txttext/plain; charset=utf-83099https://www.arca.fiocruz.br/bitstream/icict/52905/1/license.txt586c046dcfeef936e32f0323bb9a47c0MD51ORIGINALClinical_Paula_Luz_etal_INI_2022.pdfClinical_Paula_Luz_etal_INI_2022.pdfapplication/pdf364764https://www.arca.fiocruz.br/bitstream/icict/52905/2/Clinical_Paula_Luz_etal_INI_2022.pdfdb6636458e52cdb76a0af775f1317eeaMD52icict/529052022-05-25 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dc.title.pt_BR.fl_str_mv Clinical effects of durability of immunosuppression in virologically suppressed ART-initiating persons with HIV in Latin America. A retrospective cohort study
title Clinical effects of durability of immunosuppression in virologically suppressed ART-initiating persons with HIV in Latin America. A retrospective cohort study
spellingShingle Clinical effects of durability of immunosuppression in virologically suppressed ART-initiating persons with HIV in Latin America. A retrospective cohort study
Caro-Vega, Yanink
AIDS defining and non-AIDS defining events
HIV
Latin America
Sustained Virologic Response
Cumulative low CD4 counts
title_short Clinical effects of durability of immunosuppression in virologically suppressed ART-initiating persons with HIV in Latin America. A retrospective cohort study
title_full Clinical effects of durability of immunosuppression in virologically suppressed ART-initiating persons with HIV in Latin America. A retrospective cohort study
title_fullStr Clinical effects of durability of immunosuppression in virologically suppressed ART-initiating persons with HIV in Latin America. A retrospective cohort study
title_full_unstemmed Clinical effects of durability of immunosuppression in virologically suppressed ART-initiating persons with HIV in Latin America. A retrospective cohort study
title_sort Clinical effects of durability of immunosuppression in virologically suppressed ART-initiating persons with HIV in Latin America. A retrospective cohort study
author Caro-Vega, Yanink
author_facet Caro-Vega, Yanink
Rebeiro, Peter F.
Shepherd, Bryan E.
Belaunzarán-Zamudio, Pablo F.
Crabtree-Ramirez, Brenda
Cesar, Carina
Luz, Paula Mendes
Cortes, Claudia P.
Padget, Denis
Gotuzzo, Eduardo
McGowan, Catherine C.
Sierra-Madero, Juan G.
author_role author
author2 Rebeiro, Peter F.
Shepherd, Bryan E.
Belaunzarán-Zamudio, Pablo F.
Crabtree-Ramirez, Brenda
Cesar, Carina
Luz, Paula Mendes
Cortes, Claudia P.
Padget, Denis
Gotuzzo, Eduardo
McGowan, Catherine C.
Sierra-Madero, Juan G.
author2_role author
author
author
author
author
author
author
author
author
author
author
dc.contributor.author.fl_str_mv Caro-Vega, Yanink
Rebeiro, Peter F.
Shepherd, Bryan E.
Belaunzarán-Zamudio, Pablo F.
Crabtree-Ramirez, Brenda
Cesar, Carina
Luz, Paula Mendes
Cortes, Claudia P.
Padget, Denis
Gotuzzo, Eduardo
McGowan, Catherine C.
Sierra-Madero, Juan G.
dc.subject.en.pt_BR.fl_str_mv AIDS defining and non-AIDS defining events
HIV
Latin America
Sustained Virologic Response
Cumulative low CD4 counts
topic AIDS defining and non-AIDS defining events
HIV
Latin America
Sustained Virologic Response
Cumulative low CD4 counts
description This work was supported by the NIH-funded Caribbean, Central and South America network for HIV epidemiology (CCASAnet, U01AI069923), a member cohort of the International Epidemiologic Databases to Evaluate AIDS (leDEA). This award is funded by the following institutes: Eunice Kennedy Shriver National Institute Of Child Health & Human Development (NICHD), National Cancer Institute (NCI), National Institute Of Allergy And Infectious Diseases (NIAID), National Institute Of Mental Health (NIMH), the National Heart, Lung, and Blood Institute (NHLBI), the National Institute on Alcohol Abuse and Alcoholism (NIAAA), the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), and the Fogarty International Center (FIC). Specific funding was provided from the Fogarty International Center (FIC) for lead author, Yanink Caro-Vega, for the Fogarty-IeDEA Mentorship Program (FIMP).
publishDate 2022
dc.date.accessioned.fl_str_mv 2022-05-25T23:03:15Z
dc.date.available.fl_str_mv 2022-05-25T23:03:15Z
dc.date.issued.fl_str_mv 2022
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
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status_str publishedVersion
dc.identifier.citation.fl_str_mv CARO-VEGA, Yanink et al. Clinical effects of durability of immunosuppression in virologically suppressed ART-initiating persons with HIV in Latin America. A retrospective cohort study. Lancet Regional Health. Americas, v. 8, p. 1-16, 2022
dc.identifier.uri.fl_str_mv https://www.arca.fiocruz.br/handle/icict/52905
dc.identifier.issn.pt_BR.fl_str_mv 2667-193X
dc.identifier.doi.none.fl_str_mv 10.1016/j.lana.2021.100175
identifier_str_mv CARO-VEGA, Yanink et al. Clinical effects of durability of immunosuppression in virologically suppressed ART-initiating persons with HIV in Latin America. A retrospective cohort study. Lancet Regional Health. Americas, v. 8, p. 1-16, 2022
2667-193X
10.1016/j.lana.2021.100175
url https://www.arca.fiocruz.br/handle/icict/52905
dc.language.iso.fl_str_mv eng
language eng
dc.rights.driver.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv Public Library of Science
publisher.none.fl_str_mv Public Library of Science
dc.source.none.fl_str_mv reponame:Repositório Institucional da FIOCRUZ (ARCA)
instname:Fundação Oswaldo Cruz (FIOCRUZ)
instacron:FIOCRUZ
instname_str Fundação Oswaldo Cruz (FIOCRUZ)
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institution FIOCRUZ
reponame_str Repositório Institucional da FIOCRUZ (ARCA)
collection Repositório Institucional da FIOCRUZ (ARCA)
bitstream.url.fl_str_mv https://www.arca.fiocruz.br/bitstream/icict/52905/1/license.txt
https://www.arca.fiocruz.br/bitstream/icict/52905/2/Clinical_Paula_Luz_etal_INI_2022.pdf
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