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. 2024 Apr;52(2):637-648.
doi: 10.1007/s15010-024-02188-y. Epub 2024 Feb 21.

AIDS-defining events among people living with HIV who have been under continuous antiretroviral therapy for more than one year, a German cohort study 1999-2018

Annemarie Pantke  1   2 , Christian Kollan  3 , Barbara Gunsenheimer-Bartmeyer  3 , Björn-Erik Ole Jensen  4 , Christoph Stephan  5 , Olaf Degen  6 , Dirk Schürmann  7 , Tobias Kurth  8 , Viviane Bremer  3 , Uwe Koppe  3 ; HIV-1 Seroconverter Cohort and the ClinSurv HIV Cohort
Collaborators, Affiliations

AIDS-defining events among people living with HIV who have been under continuous antiretroviral therapy for more than one year, a German cohort study 1999-2018

Annemarie Pantke et al. Infection. 2024 Apr.

Abstract

Purpose: This study examined the characteristics, incidence and prognostic factors of the first AIDS-defining condition developed after more than one year of continuous antiretroviral therapy (ART) among people living with HIV (PLHIV).

Methods: We used data from two multicentre observational cohorts of PLHIV in Germany between 1999 and 2018. Our outcome was the first AIDS-defining event that occurred during follow-up after more than one year of continuous ART. Descriptive analyses at ART initiation, at the time of the AIDS event and of the most frequently observed types of AIDS-defining illnesses were performed. We calculated the incidence rate (IR) per 1000 person-years (PY) and used a bootstrap stepwise selection procedure to identify predictors of the outcome.

Results: A total of 12,466 PLHIV were included in the analyses. 378 developed the outcome, constituting an overall IR of 5.6 (95% CI 5.1-6.2) AIDS events per 1000 PY. The majority of PLHIV was virally suppressed at the time of the event. Oesophageal candidiasis and wasting syndrome were the most frequently diagnosed AIDS-defining illnesses. We found a low CD4 count at ART initiation, a previous AIDS-defining condition and transmission through intravenous drug use to be meaningful prognostic factors of the outcome.

Conclusion: The overall rate of AIDS-defining events among PLHIV under long-term ART was low, highlighting the importance of continuous treatment. PLHIV who started ART with indicators of impaired immune functioning were more susceptible to disease progression, suggesting that the public health response should continue to focus on early and sustained treatment for all PLHIV.

Keywords: AIDS; Antiretroviral therapy; Clinical surveillance; Cohort analysis; HIV-related opportunistic infections; Long-term care.

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Conflict of interest statement

The authors declare no competing interests.

The authors declare that they have no competing interests with the specific matter of the manuscript. Outside of the submitted work, TK reports having received research grants from the Gemeinsamer Bundesausschuss (G-BA—Federal Joint Committee, Germany), and from the Bundesministerium für Gesundheit (BMG—Federal Ministry of Health, Germany). He further has received personal compensation from Eli Lilly, the BMJ, and Frontiers. Outside of the submitted work, UK reports having received research grants from the Bundesministerium für Gesundheit (BMG—Federal Ministry of Health, Germany), and from the Gemeinsamer Bundesausschuss (G-BA—Federal Joint Committee, Germany). Outside of the submitted work, BEOJ reports having received consulting fees and speaker's honoraria from GSK, ViiV Healthcare, Gilead Sciences, MSD, Pfizer, AstraZeneca, Janssen-Cilag, Fresenius Medical Care and Falk Foundation.

Figures

Fig. 1
Fig. 1
Flowchart of people living with HIV (PLHIV) included in the analyses, selected from the German HIV-1 Seroconverter and ClinSurv HIV cohorts
See this image and copyright information in PMC

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