scholarly journals Recent Immigrants Show improved Clinical Outcomes at a Tertiary Care HIV Clinic

2012 ◽  
Vol 23 (1) ◽  
pp. 9-14 ◽  
Author(s):  
Janet Raboud ◽  
Sandra Blitz ◽  
Tony Antoniou ◽  
Mona Loutfy ◽  
Sharon Walmsley
Keyword(s):  
Antiretroviral Therapy ◽  
Proportional Hazards ◽  
Tertiary Care ◽  
Clinic Visit ◽  
Virologic Suppression ◽  
Combination Antiretroviral Therapy ◽  
Recent Immigrants ◽  
Time To Death ◽  
Hiv Test ◽  
Female Immigrants

BACKGROUND: In recent years, the proportion of patients attending tertiary care HIV clinics who are recent immigrants to Canada has increased dramatically.METHODS: Among patients first seen at the Toronto Hospital Immunodeficiency Clinic (Toronto, Ontario) between January 1, 2000 and August 31, 2009, the time to death from the first positive HIV test was compared between individuals who had immigrated to Canada within 10 years of their first visit and individuals who were either Canadian-born or who had immigrated more than 10 years before their first clinic visit. In addition, for the antiretroviral-naive patients in these two groups who initiated combination antiretroviral therapy, the time to and the duration of virologic suppression were compared.RESULTS: In a multivariable proportional hazards (PH) model, recent immigrant status was associated with decreased mortality (HR 0.11, P=0.03) after adjusting for age, CD4 count and the risk factor for men having sex with men. In multivariable PH models, recent female immigrants achieved virologic suppression more quickly (HR 1.51, P=0.02), while male immigrants (HR 1.14, P=0.44) and female nonimmigrants (HR 0.90, P=0.61) had similar times to virologic suppression as male nonimmigrants, respectively, after adjusting for the year of and viral load at combination antiretroviral therapy initiation. When pregnant women were removed from the analysis, there were no significant differences in the rates of virologic rebound according to sex or immigration status.DISCUSSION: Despite the perceived barriers of newcomers to Canada, mortality was lower among recent immigrants and virologic suppression was achieved more quickly in recent female immigrants.

scholarly journals All-Cause Mortality and Serious Non-AIDS Events in Adults With Low-level Human Immunodeficiency Virus Viremia During Combination Antiretroviral Therapy: Results From a Swedish Nationwide Observational Study

2020 ◽  
Author(s):  
Olof Elvstam ◽  
Gaetano Marrone ◽  
Patrik Medstrand ◽  
Carl Johan Treutiger ◽  
Anders Sönnerborg ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Viral Load ◽  
Antiretroviral Therapy ◽  
Clinical Outcomes ◽  
Virologic Suppression ◽  
Combination Antiretroviral Therapy ◽  
Low Level ◽  
Immunodeficiency Virus ◽  
All Cause Mortality ◽  
The Impact

Abstract Background The impact of low levels of human immunodeficiency virus (HIV) RNA (low-level viremia [LLV]) during combination antiretroviral therapy (cART) on clinical outcomes is unclear. We explored the associations between LLV and all-cause mortality, AIDS, and serious non-AIDS events (SNAEs). Methods We grouped individuals starting cART 1996–2017 (identified from the Swedish InfCare HIV register) as virologic suppression (VS; <50 copies/mL), LLV (repeated viral load, 50–999 copies/mL), and nonsuppressed viremia (NSV; ≥1000 copies/mL). Separately, LLV was subdivided into 50–199 and 200–999 copies/mL (reflecting different definitions of virologic failure). Proportional-hazard models (including sex, age, pre-ART CD4 count and viral load, country of birth, injection drug use, treatment experience and interruptions, and an interaction term between viremia and time) were fitted for the study outcomes. Results A total of 6956 participants were followed for a median of 5.7 years. At the end of follow-up, 60% were categorized as VS, 9% as LLV, and 31% as NSV. Compared with VS, LLV was associated with increased mortality (adjusted hazard ratio [aHR], 2.2; 95% confidence interval [CI], 1.3–3.6). This association was also observed for LLV 50–199 copies/mL (aHR, 2.2; 95% CI, 1.3–3.8), but was not statistically significant for LLV 200–999 copies/mL (aHR, 2.1; 95% CI, .96–4.7). LLV 50–999 copies/mL was not linked to increased risk of AIDS or SNAEs, but in subanalysis, LLV 200–999 copies/mL was associated with SNAEs (aHR, 2.0; 95% CI, 1.2–3.6). Conclusions In this population-based cohort, LLV during cART was associated with adverse clinical outcomes.

scholarly journals A Single Quantifiable Viral Load Is Predictive of Virological Failure in Human Immunodeficiency Virus (HIV)-Infected Patients on Combination Antiretroviral Therapy: The Austrian HIV Cohort Study

2016 ◽  
Vol 3 (2) ◽  
Author(s):  
Gisela Leierer ◽  
Katharina Grabmeier-Pfistershammer ◽  
Andrea Steuer ◽  
Mario Sarcletti ◽  
Maria Geit ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Antiretroviral Therapy ◽  
Virological Failure ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Combination Antiretroviral Therapy ◽  
Limit Of Quantification ◽  
Cox Proportional Hazards Models ◽  
Increased Risk ◽  
Immunodeficiency Virus

Abstract Background.  Viral loads (VLs) detectable at low levels are not uncommon in patients on combination antiretroviral therapy (cART). We investigated whether a single quantifiable VL predicted virological failure (VF). Methods.  We analyzed patients receiving standard regimens with at least 1 VL measurement below the limit of quantification (BLQ) in their treatment history. The first VL measurement after 6 months of unmodified cART served as baseline VL for the subsequent analyses of the time to reach single VL levels of ≥200, ≥400, and ≥1000 copies/mL. Roche TaqMan 2.0 was used to quantify human immunodeficiency virus-1 ribonucleic acid. Factors associated with VF were determined by Cox proportional hazards models. Results.  Of 1614 patients included in the study, 68, 44, and 34 experienced VF ≥200, ≥400, and ≥1000 copies/mL, respectively. In multivariable analyses, compared with patients who were BLQ, a detectable VL ≤ 50 and VL 51–199 copies/mL predicted VF ≥ 200 copies/mL (hazards ratio [HR] = 2.19, 95% confidence interval [CI] = 1.06–4.55 and HR = 4.21, 95% CI = 2.15–8.22, respectively). In those with VL 51–199 copies/mL, a trend for an increased risk of VF ≥400 and VF ≥1000 copies/mL could be found (HR = 2.13, 95% CI = 0.84–5.39 and HR = 2.52, 95% CI = 0.96–6.60, respectively). Conclusions.  These findings support closer monitoring and adherence counseling for patients with a single measurement of quantifiable VL <200 copies/mL.

scholarly journals 1001. HIV RNA monitoring after hospitalization for non-HIV-related illness in patients on combination antiretroviral therapy prior to admission

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S529-S529
Author(s):  
Paul O’Donnell ◽  
Milena M Murray ◽  
Sakhi Kauer ◽  
Reem Motan
Keyword(s):  
Antiretroviral Therapy ◽  
Hospital Discharge ◽  
Cd4 Count ◽  
People Living With Hiv ◽  
Virologic Suppression ◽  
Combination Antiretroviral Therapy ◽  
National Guidelines ◽  
Post Discharge ◽  
Hiv Rna ◽  
Multi Center Study

Abstract Background Hospitalization presents risk for loss of virologic suppression (VS) in people living with HIV (PLWH) due to issues with combination antiretroviral therapy (cART). cART medication errors or drug-drug interactions with new maintenance medications may lead to loss of VS. Appropriate monitoring of HIV RNA post-discharge to ensure ongoing VS may not occur following non-HIV-related illnesses. The objective of this multi-center study was to describe HIV RNA monitoring and VS in PLWH following hospitalization for non-HIV-related illnesses. Methods PLWH at least 18 years old with a CD4 count >200 cells/mm3 on cART prior to admission, hospitalized for 24 hours or more at either of two large, academic medical centers (where they also attended follow-up clinic visits) for a non-HIV-related illness, and that survived to hospital discharge between January 1st 2010 and December 31st 2015 were eligible for analysis. The primary outcome was the presence of an HIV RNA measurement as recommended by national guidelines within 6 months of hospital discharge. Secondary outcomes included the incidence of transient viremia and loss of VS after discharge. Results A total of 329 patients were included. The median age was 51 years (interquartile range [IQR] 44-58), 76.6% were male, and 48.3% were African American. The median CD4 count was 484 cells/mm3 (IQR 357-629) and 85.4% (n=281) had an undetectable HIV RNA prior to admission. Among the 97.6% (n=321) of patients with an HIV RNA measurement after hospital discharge, the median time to HIV RNA measurement was 2.4 months (IQR=1.2-4.1) and 86.3% (n=284) had an HIV RNA measurement within 6 months. Among patients who were undetectable prior to admission, transient viremia after discharge occurred in 7.1% (n=20) within a median of 2.5 months (IQR 1.3-4.1) and 4 of these patients lost VS. Three of the four patients with loss of VS were admitted for a non-HIV-related infection and all were on protease inhibitor-based regimens. Conclusion HIV RNA monitoring appears to occur according to guideline recommendations in the majority of PLWH after hospitalization for a non-HIV-related illness. Despite the occurrence of transient viremia, loss of VS was rare. Future studies should focus on risk factors for loss of VS. Disclosures Milena M. Murray, PharmD, MSc, BCIDP, AAHIVP, Merck (Speaker’s Bureau)

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