{Reference Type}: Journal Article
{Title}: Determinants of long-term survival in late HIV presenters: The prospective PISCIS cohort study.
{Author}: Martin-Iguacel R;Reyes-Urueña J;Bruguera A;Aceitón J;Díaz Y;Moreno-Fornés S;Domingo P;Burgos-Cibrian J;Tiraboschi JM;Johansen IS;Álvarez H;Miró JM;Casabona J;Llibre JM; ;
{Journal}: EClinicalMedicine
{Volume}: 52
{Issue}: 0
{Year}: Oct 2022
{Factor}: 17.033
{DOI}: 10.1016/j.eclinm.2022.101600
{Abstract}: <B>UNASSIGNED: </B>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.<BR><B>UNASSIGNED: </B>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.<BR><B>UNASSIGNED: </B>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]).<BR><B>UNASSIGNED: </B>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.<BR><B>UNASSIGNED: </B>Southern-Denmark University, Danish AIDS-foundation, and Region of Southern Denmark.