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. 2023 Jan 20;15(1):70-83.
doi: 10.3390/idr15010008.

Long-Term Survivors in a Cohort of People Living with HIV Diagnosed between 1985 and 1994: Predictive Factors Associated with More Than 25 Years of Survival

Federica Cosentino  1   2 , Andrea Marino  2   3 , Laura Anile  4 , Vittoria Moscatt  1   2 , Maria Gussio  2 , Vincenzo Boscia  2 , Roberto Bruno  2   5 , Giuseppe Nunnari  1 , Alfredo Pulvirenti  6 , Grete Francesca Privitera  6 , Bruno Santi Cacopardo  2   5 , Manuela Ceccarelli  2   5   7 , Benedetto Maurizio Celesia  2
Affiliations

Long-Term Survivors in a Cohort of People Living with HIV Diagnosed between 1985 and 1994: Predictive Factors Associated with More Than 25 Years of Survival

Federica Cosentino et al. Infect Dis Rep. .

Abstract

Although the mortality rate among individuals diagnosed during the pre-Highly Active Antiretroviral Treatment era has been substantial, a considerable number of them survived. Our study aimed to evaluate the prevalence of HIV long-term survivors in a cohort of People Living with HIV diagnosed between 1985 and 1994 and to speculate about potential predictive factors associated to long survival. This is a retrospective single-center study. Subjects surviving more than 300 months (25 years) from HIV diagnosis were defined as Long Term Survivors. Overall, 210 subjects were enrolled. More than 75.24% of the included people living with HIV were males, with a median age of 28 years (IQR 25-34). The prevalent risk factors for HIV infection were injection drug use (47.62%), followed by unprotected sex among heterosexual individuals (23.81%). Ninety-three individuals (44.29%) could be defined as LTS with a median (IQR) survival of 333 (312-377) months. A hazard ratio of 12.45 (95% CI 7.91-19.59) was found between individuals who were exposed to Highly Active AntiRetroviral Treatment (HAART) and individuals who were not, with the latter being at greater risk of death. The availability and accessibility of effective antiretroviral therapy for people living with HIV remain the cornerstone of survival.

Keywords: HAART; HIV epidemiology; long-term survivors.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Overall survival among HIV population. This figure shows the overall survival of the cohort of People Living with HIV (PLWH) diagnosed between 1985–1994 in follow-up at the HIV outpatient clinic of the Unit of Infectious Diseases of the “Garibaldi” Hospital in Catania, Italy. At the end of the period of observation, 42.9% of the cohort was still alive.
Figure 2
Figure 2
Probability of survival stratified by access to HAART treatment. This figure shows the difference in survival time between individuals who had access to HAART (red line) vs. individuals who did not receive HAART (blue line). Hazard ratio (log-rank) was 12.45 (95% CI 7.91–19.59, p < 0.001), with no-HAART subjects being at higher risk of death than people who took HAART. Abbreviations: HAART—highly active antiretroviral treatment.
Figure 3
Figure 3
CD4+ T-cell count at diagnosis in People Living with HIV (PLWH) having access to Highly Active Anti-Retroviral Treatment (HAART). This figure shows that in PLWH who had access to HAART, CD4+ T-cell count was not significantly different between non-long-term survivors (red) and long-term survivors (blue), even when stratifying by CDC ’93 category. Whiskers represent the 95% CI. Abbreviations: PLWH—people living with HIV; HAART—highly active antiretroviral therapy; NLTS—non-long-term survivors; LTS—long-term survivors.
Figure 4
Figure 4
CD4+ T-cell count at diagnosis influences survival time in LTS- but not in NLTS-PLWH on HAART. This figure shows that in LTS-PLWH (blue lines and dots), a statistically significant relationship exists between CD4+ T-cell count at diagnosis and time of survival. Abbreviations: LTS—long-term survivors; NLTS—non-long-term survivors; PLWH—people living with HIV; HAART—highly active antiretroviral therapy.
Figure 5
Figure 5
CD4+/CD8+ ratio at diagnosis in PLWH who had access to HAART. This figure shows that at diagnosis, there was no statistically significant difference between NLTS-PLWH (red) and LTS-PLWH (blue) in terms of CD4/CD8 ratio when stratifying by ratio higher or lower than 0.5. Abbreviations: PLWH—people living with HIV; HAART—highly active antiretroviral treatment; NLTS—non-long-term survivors; LTS—long-term survivors.
Figure 6
Figure 6
CD4+/CD8+ ratio at diagnosis is not a good predictor of survival. This figure shows that there is no statistically significant difference in terms of survival between those who were diagnosed with a CD4+/CD8+ ratio lower than 0.5 (blue) and those who received their diagnosis when the CD4+/CD8+ ratio was higher than 0.5 (red). All the PLWH included in this analysis received HAART.
Figure 7
Figure 7
Age at diagnosis influences time of survival. This figure shows that a linear correlation might exist between age at diagnosis and time of survival, although this correlation is weak (R squared 0.128).
Figure 8
Figure 8
AIDS-related events influence the survival rate in PLWH who had access to HAART. This figure shows that in PLWH who were taking HAART, the appearance of an AIDS-related event is a negative prognostic factor for survival. Hazard ratio of those who had an AIDS-related disease was 4.329 (95% CI 1.866–10.040) compared with those who did not have an AIDS-related event, meaning that they had a 4-fold higher risk of dying. Abbreviations: AIDS—acquired immunodeficiency syndrome; PLWH—people living with HIV; HAART—highly active antiretroviral treatment.
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