Opportunistic infections and AIDS malignancies early after initiating combination antiretroviral therapy in high-income countries

The HIV-CAUSAL Collaboration

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background: There is little information on the incidence of AIDS-defining events which have been reported in the literature to be associated with immune reconstitution inflammatory syndrome (IRIS) after combined antiretroviral therapy (cART) initiation. These events include tuberculosis, mycobacterium avium complex (MAC), cytomegalovirus (CMV) retinitis, progressive multifocal leukoencephalopathy (PML), herpes simplex virus (HSV), Kaposi sarcoma, non-Hodgkin lymphoma (NHL), cryptococcosis and candidiasis.

Methods: We identified individuals in the HIV-CAUSAL Collaboration, which includes data from six European countries and the US, who were HIV-positive between 1996 and 2013, antiretroviral therapy naive, aged at least 18 years, hadCD4+ cell count and HIV-RNA measurements and had been AIDS-free for at least 1 month between those measurements and the start of follow-up. For each AIDS-defining event, we estimated the hazard ratio for no cART versus less than 3 and at least 3 months since cART initiation, adjusting for time-varying CD4+ cell count and HIV-RNA via inverse probability weighting.

Results: Out of 96 562 eligible individuals (78% men) with median (interquantile range) follow-up of 31 [13,65] months, 55 144 initiated cART. The number of cases varied between 898 for tuberculosis and 113 for PML. Compared with non-cART initiation, the hazard ratio (95% confidence intervals) up to 3 months after cART initiation were 1.21 (0.90-1.63) for tuberculosis, 2.61 (1.05-6.49) for MAC, 1.17 (0.34-4.08) for CMV retinitis, 1.18 (0.62-2.26) for PML, 1.21 (0.83-1.75) for HSV, 1.18 (0.87-1.58) for Kaposi sarcoma, 1.56 (0.82-2.95) for NHL, 1.11 (0.56-2.18) for cryptococcosis and 0.77 (0.40-1.49) for candidiasis.

Conclusion: With the potential exception of mycobacterial infections, unmasking IRIS does not appear to be a common complication of cART initiation in high-income countries.

Original languageEnglish (US)
Pages (from-to)2461-2473
Number of pages13
JournalAIDS
Volume28
Issue number16
DOIs
StatePublished - Jan 1 2014
Externally publishedYes

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Opportunistic Infections
Acquired Immunodeficiency Syndrome
Progressive Multifocal Leukoencephalopathy
Neoplasms
Immune Reconstitution Inflammatory Syndrome
HIV
Cytomegalovirus Retinitis
Mycobacterium avium Complex
Cryptococcosis
Tuberculosis
Candidiasis
Kaposi's Sarcoma
Simplexvirus
Therapeutics
Non-Hodgkin's Lymphoma
RNA
CD4 Lymphocyte Count
Cell Count
Confidence Intervals
Incidence

Keywords

  • HIV
  • Immune reconstitution inflammatory syndrome
  • Incidence
  • Inverse probability weighting
  • Unmasking

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Infectious Diseases

Cite this

Opportunistic infections and AIDS malignancies early after initiating combination antiretroviral therapy in high-income countries. / The HIV-CAUSAL Collaboration.

In: AIDS, Vol. 28, No. 16, 01.01.2014, p. 2461-2473.

Research output: Contribution to journalArticle

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abstract = "Background: There is little information on the incidence of AIDS-defining events which have been reported in the literature to be associated with immune reconstitution inflammatory syndrome (IRIS) after combined antiretroviral therapy (cART) initiation. These events include tuberculosis, mycobacterium avium complex (MAC), cytomegalovirus (CMV) retinitis, progressive multifocal leukoencephalopathy (PML), herpes simplex virus (HSV), Kaposi sarcoma, non-Hodgkin lymphoma (NHL), cryptococcosis and candidiasis.Methods: We identified individuals in the HIV-CAUSAL Collaboration, which includes data from six European countries and the US, who were HIV-positive between 1996 and 2013, antiretroviral therapy naive, aged at least 18 years, hadCD4+ cell count and HIV-RNA measurements and had been AIDS-free for at least 1 month between those measurements and the start of follow-up. For each AIDS-defining event, we estimated the hazard ratio for no cART versus less than 3 and at least 3 months since cART initiation, adjusting for time-varying CD4+ cell count and HIV-RNA via inverse probability weighting.Results: Out of 96 562 eligible individuals (78{\%} men) with median (interquantile range) follow-up of 31 [13,65] months, 55 144 initiated cART. The number of cases varied between 898 for tuberculosis and 113 for PML. Compared with non-cART initiation, the hazard ratio (95{\%} confidence intervals) up to 3 months after cART initiation were 1.21 (0.90-1.63) for tuberculosis, 2.61 (1.05-6.49) for MAC, 1.17 (0.34-4.08) for CMV retinitis, 1.18 (0.62-2.26) for PML, 1.21 (0.83-1.75) for HSV, 1.18 (0.87-1.58) for Kaposi sarcoma, 1.56 (0.82-2.95) for NHL, 1.11 (0.56-2.18) for cryptococcosis and 0.77 (0.40-1.49) for candidiasis.Conclusion: With the potential exception of mycobacterial infections, unmasking IRIS does not appear to be a common complication of cART initiation in high-income countries.",
keywords = "HIV, Immune reconstitution inflammatory syndrome, Incidence, Inverse probability weighting, Unmasking",
author = "{The HIV-CAUSAL Collaboration} and Sara Lodi and {Del Amo}, Julia and Santiago Moreno and Bucher, {Heiner C.} and Hansjakob Furrer and Roger Logan and Jonathan Sterne and Santiago P{\'e}rez-Hoyos and Inma Jarr{\'i}n and Andrew Phillips and Ashley Olson and {Van Sighem}, Ard and Peter Reiss and Caroline Sabin and Sophie Jose and Amy Justice and Joseph Goulet and Mir{\'o}, {Jos{\'e} M.} and Elena Ferrer and Laurence Meyer and R{\'e}monie Seng and Georgia Vourli and Anastasia Antoniadou and Francois Dabis and Vandenhede, {Mari Anne} and Dominique Costagliola and Sophie Abgrall and Hern{\'a}n, {Miguel A.} and Miguel Hernan and L. Bansi and T. Hill and C. Sabin and D. Dunn and K. Porter and A. Glabay and C. Orkin and R. Thomas and K. Jones and M. Fisher and N. Perry and A. Pullin and D. Churchill and B. Gazzard and M. Nelson and D. Asboe and S. Bulbeck and S. Mandalia and J. Clarke and V. Delpech and Giorgos Bakoyannis",
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TY - JOUR

T1 - Opportunistic infections and AIDS malignancies early after initiating combination antiretroviral therapy in high-income countries

AU - The HIV-CAUSAL Collaboration

AU - Lodi, Sara

AU - Del Amo, Julia

AU - Moreno, Santiago

AU - Bucher, Heiner C.

AU - Furrer, Hansjakob

AU - Logan, Roger

AU - Sterne, Jonathan

AU - Pérez-Hoyos, Santiago

AU - Jarrín, Inma

AU - Phillips, Andrew

AU - Olson, Ashley

AU - Van Sighem, Ard

AU - Reiss, Peter

AU - Sabin, Caroline

AU - Jose, Sophie

AU - Justice, Amy

AU - Goulet, Joseph

AU - Miró, José M.

AU - Ferrer, Elena

AU - Meyer, Laurence

AU - Seng, Rémonie

AU - Vourli, Georgia

AU - Antoniadou, Anastasia

AU - Dabis, Francois

AU - Vandenhede, Mari Anne

AU - Costagliola, Dominique

AU - Abgrall, Sophie

AU - Hernán, Miguel A.

AU - Hernan, Miguel

AU - Bansi, L.

AU - Hill, T.

AU - Sabin, C.

AU - Dunn, D.

AU - Porter, K.

AU - Glabay, A.

AU - Orkin, C.

AU - Thomas, R.

AU - Jones, K.

AU - Fisher, M.

AU - Perry, N.

AU - Pullin, A.

AU - Churchill, D.

AU - Gazzard, B.

AU - Nelson, M.

AU - Asboe, D.

AU - Bulbeck, S.

AU - Mandalia, S.

AU - Clarke, J.

AU - Delpech, V.

AU - Bakoyannis, Giorgos

PY - 2014/1/1

Y1 - 2014/1/1

N2 - Background: There is little information on the incidence of AIDS-defining events which have been reported in the literature to be associated with immune reconstitution inflammatory syndrome (IRIS) after combined antiretroviral therapy (cART) initiation. These events include tuberculosis, mycobacterium avium complex (MAC), cytomegalovirus (CMV) retinitis, progressive multifocal leukoencephalopathy (PML), herpes simplex virus (HSV), Kaposi sarcoma, non-Hodgkin lymphoma (NHL), cryptococcosis and candidiasis.Methods: We identified individuals in the HIV-CAUSAL Collaboration, which includes data from six European countries and the US, who were HIV-positive between 1996 and 2013, antiretroviral therapy naive, aged at least 18 years, hadCD4+ cell count and HIV-RNA measurements and had been AIDS-free for at least 1 month between those measurements and the start of follow-up. For each AIDS-defining event, we estimated the hazard ratio for no cART versus less than 3 and at least 3 months since cART initiation, adjusting for time-varying CD4+ cell count and HIV-RNA via inverse probability weighting.Results: Out of 96 562 eligible individuals (78% men) with median (interquantile range) follow-up of 31 [13,65] months, 55 144 initiated cART. The number of cases varied between 898 for tuberculosis and 113 for PML. Compared with non-cART initiation, the hazard ratio (95% confidence intervals) up to 3 months after cART initiation were 1.21 (0.90-1.63) for tuberculosis, 2.61 (1.05-6.49) for MAC, 1.17 (0.34-4.08) for CMV retinitis, 1.18 (0.62-2.26) for PML, 1.21 (0.83-1.75) for HSV, 1.18 (0.87-1.58) for Kaposi sarcoma, 1.56 (0.82-2.95) for NHL, 1.11 (0.56-2.18) for cryptococcosis and 0.77 (0.40-1.49) for candidiasis.Conclusion: With the potential exception of mycobacterial infections, unmasking IRIS does not appear to be a common complication of cART initiation in high-income countries.

AB - Background: There is little information on the incidence of AIDS-defining events which have been reported in the literature to be associated with immune reconstitution inflammatory syndrome (IRIS) after combined antiretroviral therapy (cART) initiation. These events include tuberculosis, mycobacterium avium complex (MAC), cytomegalovirus (CMV) retinitis, progressive multifocal leukoencephalopathy (PML), herpes simplex virus (HSV), Kaposi sarcoma, non-Hodgkin lymphoma (NHL), cryptococcosis and candidiasis.Methods: We identified individuals in the HIV-CAUSAL Collaboration, which includes data from six European countries and the US, who were HIV-positive between 1996 and 2013, antiretroviral therapy naive, aged at least 18 years, hadCD4+ cell count and HIV-RNA measurements and had been AIDS-free for at least 1 month between those measurements and the start of follow-up. For each AIDS-defining event, we estimated the hazard ratio for no cART versus less than 3 and at least 3 months since cART initiation, adjusting for time-varying CD4+ cell count and HIV-RNA via inverse probability weighting.Results: Out of 96 562 eligible individuals (78% men) with median (interquantile range) follow-up of 31 [13,65] months, 55 144 initiated cART. The number of cases varied between 898 for tuberculosis and 113 for PML. Compared with non-cART initiation, the hazard ratio (95% confidence intervals) up to 3 months after cART initiation were 1.21 (0.90-1.63) for tuberculosis, 2.61 (1.05-6.49) for MAC, 1.17 (0.34-4.08) for CMV retinitis, 1.18 (0.62-2.26) for PML, 1.21 (0.83-1.75) for HSV, 1.18 (0.87-1.58) for Kaposi sarcoma, 1.56 (0.82-2.95) for NHL, 1.11 (0.56-2.18) for cryptococcosis and 0.77 (0.40-1.49) for candidiasis.Conclusion: With the potential exception of mycobacterial infections, unmasking IRIS does not appear to be a common complication of cART initiation in high-income countries.

KW - HIV

KW - Immune reconstitution inflammatory syndrome

KW - Incidence

KW - Inverse probability weighting

KW - Unmasking

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DO - 10.1097/QAD.0000000000000456

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