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.
■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。