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Abstract：
UNASSIGNED: Late HIV diagnosis (i.e CD4≤350 cells/µL) is associated with poorer outcomes. However, determinants of long-term mortality and factors influencing immune recovery within the first years after antiretroviral treatment (ART) initiation are poorly defined.
UNASSIGNED: From PISCIS cohort, we included all HIV-positive adults, two-year survivors after initiating ART between 2005-2019. The primary outcome was all-cause mortality according to the two-year CD4 count. We used Poisson regression. The secondary outcome was incomplete immune recovery (i.e., two-year CD4<500 cells/µL). We used logistic regression and propensity score matching.
UNASSIGNED: We included 2,719 participants (16593·1 person-years): 1441 (53%) late presenters (LP) and 1278 non-LP (1145 non-LP with two-year CD4 count >500 cells/µL, reference population). Overall, 113 patients (4·2%) died. Mortality was higher among LP with two-year CD4 count 200-500 cells/µL (aMRR 1·95[95%CI:1·06-3·61]) or <200 cells/µL (aMRR 4·59[2·25-9·37]).Conversely, no differences were observed in participants with two-year CD4 counts >500 cells/µL, regardless of being initially LP or non-LP (aMRR 1·05[0·50-2·21]). Mortality rates within each two-year CD4 strata were not affected by the initial CD4 count at ART initiation (test-interaction, p = 0·48). The stronger factor influencing immune recovery was the CD4 count at ART initiation. First-line integrase-inhibitor-(INSTI)-based regimens were associated with reduced mortality compared to other regimens (aMRR 0·54[0·31-0·93]) and reduced risk of incomplete immune recovery in LP (aOR 0·70[0·52-0·95]).
UNASSIGNED: Two-year immune recovery is a good early predictor of long-term mortality in LP after surviving the first high-risk 2 years. Nearly half experienced a favorable immune recovery with a life expectancy similar to non-LP. INSTI-based regimens were associated with higher rates of successful immune recovery and better survival compared to non-INSTI regimens.
UNASSIGNED: Southern-Denmark University, Danish AIDS-foundation, and Region of Southern Denmark.
UNASSIGNED: From PISCIS cohort, we included all HIV-positive adults, two-year survivors after initiating ART between 2005-2019. The primary outcome was all-cause mortality according to the two-year CD4 count. We used Poisson regression. The secondary outcome was incomplete immune recovery (i.e., two-year CD4<500 cells/µL). We used logistic regression and propensity score matching.
UNASSIGNED: We included 2,719 participants (16593·1 person-years): 1441 (53%) late presenters (LP) and 1278 non-LP (1145 non-LP with two-year CD4 count >500 cells/µL, reference population). Overall, 113 patients (4·2%) died. Mortality was higher among LP with two-year CD4 count 200-500 cells/µL (aMRR 1·95[95%CI:1·06-3·61]) or <200 cells/µL (aMRR 4·59[2·25-9·37]).Conversely, no differences were observed in participants with two-year CD4 counts >500 cells/µL, regardless of being initially LP or non-LP (aMRR 1·05[0·50-2·21]). Mortality rates within each two-year CD4 strata were not affected by the initial CD4 count at ART initiation (test-interaction, p = 0·48). The stronger factor influencing immune recovery was the CD4 count at ART initiation. First-line integrase-inhibitor-(INSTI)-based regimens were associated with reduced mortality compared to other regimens (aMRR 0·54[0·31-0·93]) and reduced risk of incomplete immune recovery in LP (aOR 0·70[0·52-0·95]).
UNASSIGNED: Two-year immune recovery is a good early predictor of long-term mortality in LP after surviving the first high-risk 2 years. Nearly half experienced a favorable immune recovery with a life expectancy similar to non-LP. INSTI-based regimens were associated with higher rates of successful immune recovery and better survival compared to non-INSTI regimens.
UNASSIGNED: Southern-Denmark University, Danish AIDS-foundation, and Region of Southern Denmark.
摘要：
■晚期艾滋病毒诊断（i。eCD4≤350个细胞/μL)与较差的预后相关。然而,抗逆转录病毒治疗(ART)开始后的头几年内,长期死亡率的决定因素和影响免疫恢复的因素尚不明确.
■来自PISIS队列，我们包括了所有艾滋病毒阳性的成年人，在2005-2019年间启动ART后的两年幸存者。主要结果是根据两年CD4计数的全因死亡率。我们使用泊松回归。次要结果是免疫恢复不完全(即，两年CD4<500个细胞/微升)。我们使用逻辑回归和倾向评分匹配。
■我们包括2,719名参与者（16593·1人年）：1441（53％）晚期陈述者（LP）和1278非LP（1145非LP，两年CD4计数>500细胞/µL，参考人口)。总的来说,113例（4.2%）死亡。两年CD4计数为200-500个细胞/µL（aMRR1·95[95CI:1·06-3·61]）或<200个细胞/µL（aMRR4·59[2·25-9·37]）的LP死亡率较高。相反，在两年CD4计数>500个细胞/微升的参与者中没有观察到差异，无论最初是LP还是非LP（aMRR1·05[0·50-2·21]）。每两年CD4层的死亡率不受ART开始时初始CD4计数的影响（测试相互作用，p=0·48）。影响免疫恢复的较强因素是ART开始时的CD4计数。与其他方案相比，一线整合酶抑制剂（INSTI）方案可降低死亡率（aMRR0·54[0·31-0·93]），并降低LP免疫恢复不完全的风险（aOR0·70[0·52-0·95]）。
■在第一个高风险2年存活后，两年的免疫恢复是LP长期死亡率的良好早期预测指标。近一半的人经历了良好的免疫恢复，预期寿命与非LP相似。与非INSTI方案相比，基于INSTI的方案具有更高的成功免疫恢复率和更好的生存率。
■南丹麦大学，丹麦艾滋病基金会，和丹麦南部地区。
■来自PISIS队列，我们包括了所有艾滋病毒阳性的成年人，在2005-2019年间启动ART后的两年幸存者。主要结果是根据两年CD4计数的全因死亡率。我们使用泊松回归。次要结果是免疫恢复不完全(即，两年CD4<500个细胞/微升)。我们使用逻辑回归和倾向评分匹配。
■我们包括2,719名参与者（16593·1人年）：1441（53％）晚期陈述者（LP）和1278非LP（1145非LP，两年CD4计数>500细胞/µL，参考人口)。总的来说,113例（4.2%）死亡。两年CD4计数为200-500个细胞/µL（aMRR1·95[95CI:1·06-3·61]）或<200个细胞/µL（aMRR4·59[2·25-9·37]）的LP死亡率较高。相反，在两年CD4计数>500个细胞/微升的参与者中没有观察到差异，无论最初是LP还是非LP（aMRR1·05[0·50-2·21]）。每两年CD4层的死亡率不受ART开始时初始CD4计数的影响（测试相互作用，p=0·48）。影响免疫恢复的较强因素是ART开始时的CD4计数。与其他方案相比，一线整合酶抑制剂（INSTI）方案可降低死亡率（aMRR0·54[0·31-0·93]），并降低LP免疫恢复不完全的风险（aOR0·70[0·52-0·95]）。
■在第一个高风险2年存活后，两年的免疫恢复是LP长期死亡率的良好早期预测指标。近一半的人经历了良好的免疫恢复，预期寿命与非LP相似。与非INSTI方案相比，基于INSTI的方案具有更高的成功免疫恢复率和更好的生存率。
■南丹麦大学，丹麦艾滋病基金会，和丹麦南部地区。
