Persistent poor clinical outcomes of people living with HIV presenting with AIDS and late HIV diagnosis – results from the ICONA cohort in Italy, 2009-2022
Objectives: Limited data are available on the long-term outcomes in recent years for late HIV diagnosis (LD). Methods: All subjects with HIV enrolled in the ICONA cohort in 2009-2022 who started antiretroviral treatment (ART) within 4 months from diagnosis were included and divided into: (i) pre-ART...
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| Format: | Article |
| Language: | English |
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Elsevier
2024-05-01
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| Series: | International Journal of Infectious Diseases |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S1201971224000663 |
| _version_ | 1797209675851104256 |
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| author | Annalisa Mondi Alessandro Cozzi-Lepri Alessandro Tavelli Antonella Cingolani Andrea Giacomelli Giancarlo Orofino Gabriella De Girolamo Carmela Pinnetti Andrea Gori Annalisa Saracino Alessandra Bandera Giulia Marchetti Enrico Girardi Cristina Mussini Antonella d'Arminio Monforte Andrea Antinori |
| author_facet | Annalisa Mondi Alessandro Cozzi-Lepri Alessandro Tavelli Antonella Cingolani Andrea Giacomelli Giancarlo Orofino Gabriella De Girolamo Carmela Pinnetti Andrea Gori Annalisa Saracino Alessandra Bandera Giulia Marchetti Enrico Girardi Cristina Mussini Antonella d'Arminio Monforte Andrea Antinori |
| author_sort | Annalisa Mondi |
| collection | DOAJ |
| description | Objectives: Limited data are available on the long-term outcomes in recent years for late HIV diagnosis (LD). Methods: All subjects with HIV enrolled in the ICONA cohort in 2009-2022 who started antiretroviral treatment (ART) within 4 months from diagnosis were included and divided into: (i) pre-ART CD4 count ≥350/mm3 without AIDS (non-LD), (ii) pre-ART CD4 count <350/mm3 without AIDS (LD asymptomatic), and (iii) with AIDS events pre-ART (LD-AIDS). The estimated probability and independent risk for mortality (all-cause and cause-specific) and treatment failure were evaluated. Results: Of 6813 participants (2448 non-LD, 3198 LD asymptomatic, and 1167 LD-AIDS), 161 (2.4%) died after ART initiation. At survival analysis, a higher probability of all-cause mortality has been identified for LD than non-LD (P <0.001) and within the former, for LD-AIDS over LD asymptomatic (P <0.001). After adjusting for confounders, LD showed a higher risk of all-cause mortality (vs non-LD adjusted hazard ratio (aHR) 5.51, P <0.001) and, in particular, being an AIDS presenter predicted a greater risk of all-cause (aHR = 4.42, P <0.001), AIDS-related (adjusted subhazard ratio [aSHR] = 16.86, P <0.001), and non-AIDS–related mortality (aSHR = 1.74, P = 0.022) than the rest of the late presenters. Among the short-term survivors in the LD-AIDS group, the long-term mortality was mediated by the lack of immune recovery at 2 years. Finally, LD compared with non-LD and, particularly, among the former, LD-AIDS over LD asymptomatic showed a greater risk of treatment failure. Conclusions: In recent years, LD subjects, particularly, AIDS presenters, remained at a higher risk of poorer outcomes. Public health strategies for early HIV diagnosis are urgently needed to constrain the mortality gap. |
| first_indexed | 2024-04-24T09:58:29Z |
| format | Article |
| id | doaj.art-35c48fd2f14a4981ae16004ca2d06964 |
| institution | Directory Open Access Journal |
| issn | 1201-9712 |
| language | English |
| last_indexed | 2024-04-24T09:58:29Z |
| publishDate | 2024-05-01 |
| publisher | Elsevier |
| record_format | Article |
| series | International Journal of Infectious Diseases |
| spelling | doaj.art-35c48fd2f14a4981ae16004ca2d069642024-04-14T04:10:13ZengElsevierInternational Journal of Infectious Diseases1201-97122024-05-01142106995Persistent poor clinical outcomes of people living with HIV presenting with AIDS and late HIV diagnosis – results from the ICONA cohort in Italy, 2009-2022Annalisa Mondi0Alessandro Cozzi-Lepri1Alessandro Tavelli2Antonella Cingolani3Andrea Giacomelli4Giancarlo Orofino5Gabriella De Girolamo6Carmela Pinnetti7Andrea Gori8Annalisa Saracino9Alessandra Bandera10Giulia Marchetti11Enrico Girardi12Cristina Mussini13Antonella d'Arminio Monforte14Andrea Antinori15Clinical Department of Infectious Diseases, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, ItalyCentre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, University College London, London, UKICONA Foundation, Milan, Italy; Corresponding author: Alessandro Tavelli, Tel.: +39 0281843061.Section of Infectious Diseases, Department of Safety and Bioethics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, ItalyDivision 3 of Infectious Diseases, ASST Fatebenefratelli-Sacco, Milan, ItalyDivision I of Infectious and Tropical Diseases, ASL Città di Torino, Torino, ItalyDepartment of Public Health and Infectious Diseases, Policlinico Umberto I, Sapienza University, Rome, ItalyClinical Department of Infectious Diseases, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, ItalyDivision 2 of Infectious Diseases, ASST Fatebenefratelli-Sacco, University of Milan, Milan, ItalyClinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area, Polyclinic of Bari, University Hospital Polyclinic, University of Bari, Bari, ItalyClinic of Infectious Diseases, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Pathophysiology and Transplantation, University of Milan, Milan, ItalyClinic of Infectious Diseases, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, ItalyScientific Direction, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, ItalyDepartment of Infectious Diseases, Azienda Ospedaliero Universitaria Policlinico of Modena, Modena, ItalyICONA Foundation, Milan, ItalyClinical Department of Infectious Diseases, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, ItalyObjectives: Limited data are available on the long-term outcomes in recent years for late HIV diagnosis (LD). Methods: All subjects with HIV enrolled in the ICONA cohort in 2009-2022 who started antiretroviral treatment (ART) within 4 months from diagnosis were included and divided into: (i) pre-ART CD4 count ≥350/mm3 without AIDS (non-LD), (ii) pre-ART CD4 count <350/mm3 without AIDS (LD asymptomatic), and (iii) with AIDS events pre-ART (LD-AIDS). The estimated probability and independent risk for mortality (all-cause and cause-specific) and treatment failure were evaluated. Results: Of 6813 participants (2448 non-LD, 3198 LD asymptomatic, and 1167 LD-AIDS), 161 (2.4%) died after ART initiation. At survival analysis, a higher probability of all-cause mortality has been identified for LD than non-LD (P <0.001) and within the former, for LD-AIDS over LD asymptomatic (P <0.001). After adjusting for confounders, LD showed a higher risk of all-cause mortality (vs non-LD adjusted hazard ratio (aHR) 5.51, P <0.001) and, in particular, being an AIDS presenter predicted a greater risk of all-cause (aHR = 4.42, P <0.001), AIDS-related (adjusted subhazard ratio [aSHR] = 16.86, P <0.001), and non-AIDS–related mortality (aSHR = 1.74, P = 0.022) than the rest of the late presenters. Among the short-term survivors in the LD-AIDS group, the long-term mortality was mediated by the lack of immune recovery at 2 years. Finally, LD compared with non-LD and, particularly, among the former, LD-AIDS over LD asymptomatic showed a greater risk of treatment failure. Conclusions: In recent years, LD subjects, particularly, AIDS presenters, remained at a higher risk of poorer outcomes. Public health strategies for early HIV diagnosis are urgently needed to constrain the mortality gap.http://www.sciencedirect.com/science/article/pii/S1201971224000663Late presentersAIDSMortalityHIVImmune recovery |
| spellingShingle | Annalisa Mondi Alessandro Cozzi-Lepri Alessandro Tavelli Antonella Cingolani Andrea Giacomelli Giancarlo Orofino Gabriella De Girolamo Carmela Pinnetti Andrea Gori Annalisa Saracino Alessandra Bandera Giulia Marchetti Enrico Girardi Cristina Mussini Antonella d'Arminio Monforte Andrea Antinori Persistent poor clinical outcomes of people living with HIV presenting with AIDS and late HIV diagnosis – results from the ICONA cohort in Italy, 2009-2022 International Journal of Infectious Diseases Late presenters AIDS Mortality HIV Immune recovery |
| title | Persistent poor clinical outcomes of people living with HIV presenting with AIDS and late HIV diagnosis – results from the ICONA cohort in Italy, 2009-2022 |
| title_full | Persistent poor clinical outcomes of people living with HIV presenting with AIDS and late HIV diagnosis – results from the ICONA cohort in Italy, 2009-2022 |
| title_fullStr | Persistent poor clinical outcomes of people living with HIV presenting with AIDS and late HIV diagnosis – results from the ICONA cohort in Italy, 2009-2022 |
| title_full_unstemmed | Persistent poor clinical outcomes of people living with HIV presenting with AIDS and late HIV diagnosis – results from the ICONA cohort in Italy, 2009-2022 |
| title_short | Persistent poor clinical outcomes of people living with HIV presenting with AIDS and late HIV diagnosis – results from the ICONA cohort in Italy, 2009-2022 |
| title_sort | persistent poor clinical outcomes of people living with hiv presenting with aids and late hiv diagnosis results from the icona cohort in italy 2009 2022 |
| topic | Late presenters AIDS Mortality HIV Immune recovery |
| url | http://www.sciencedirect.com/science/article/pii/S1201971224000663 |
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