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Randomized Controlled Trial
. 2022 Aug;23(7):717-726.
doi: 10.1111/hiv.13230. Epub 2022 Jan 12.

Plasma sVCAM-1, antiretroviral therapy and mortality in HIV-1-infected West African adults

Roseline Affi  1   2   3 , Delphine Gabillard  2   4 , Gérard Menan Kouame  2   4 , Jean Baptiste Ntakpe  2   4 , Raoul Moh  2   3 , Anani Badje  2   3 , Christine Danel  2   4 , André Inwoley  1   2   3 , Serge P Eholié  2   3 , Xavier Anglaret  2   4 , Laurence Weiss  5   6   7
Affiliations
Free article
Randomized Controlled Trial

Plasma sVCAM-1, antiretroviral therapy and mortality in HIV-1-infected West African adults

Roseline Affi et al. HIV Med. 2022 Aug.
Free article

Abstract

Objectives: We report the association between pre-antiretroviral therapy (pre-ART) soluble vascular cell adhesion molecule-1 (sVCAM-1) levels and long-term mortality in HIV-infected West African adults participating in a trial of early ART in West Africa (Temprano ANRS 12136 trial).

Methods: The ART-naïve HIV-infected adults were randomly assigned to start ART immediately or defer ART until the WHO criteria were met. Participants who completed the trial follow-up were invited to participate in a post-trial phase (PTP). The PTP end-point was all-cause death. We used multivariable Cox proportional models to analyse the association between baseline sVCAM-1 and all-cause death, adjusting for ART strategy, sex, CD4 count, plasma HIV-1 RNA and peripheral blood mononuclear cell HIV-1 DNA levels.

Results: In all, 954 adults (77% women, median CD4 count of 387 cells/μL) were randomly assigned to start ART immediately (n = 477) or to defer initiation of ART (n = 477). They were followed for a median of 5.8 years [interquartile range (IQR): 5.2-6.3]. In multivariable analysis, the risk of death was significantly associated with baseline sVCAM-1 [≥1458 vs. < 1458 ng/mL; adjusted hazard ratio = 2.86, 95% confidence interval (CI): 1.60-5.11]. The 6-year probability of death rates were 14.4% (95%CI: 9.1-22.6) and 9.4% (5.4-16.1) in patients with baseline sVCAM-1 ≥ 1458 ng/mL randomized to deferred and immediate ART, respectively, and 3.8% (2.2-6.5) and 3.5% (1.9-6.3) in patients with baseline sVCAM-1 < 1458 ng/mL randomized to deferred and immediate ART. The median difference between pre-ART and 12-month sVCAM-1 levels in patients randomized to immediate ART was -252 (IQR: -587 to -61).

Conclusions: Pre-ART sVCAM-1 levels were significantly associated with mortality, independently of whether ART was started immediately or deferred, but they significantly decreased after 12 months of ART.

Keywords: antiretroviral therapy; endothelial dysfunction; mortality; sub-Saharan Africa.

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References

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