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
Authors: Pantke Annemarie , Kollan Christian , Gunsenheimer-Bartmeyer Barbara , Jensen Björn-Erik Ole , Stephan Christoph , Degen Olaf , Schürmann Dirk , Kurth Tobias , Bremer Viviane , Koppe Uwe ,   the HIV-1 Seroconverter Cohort and the ClinSurv HIV Cohort, Knechten Heribert , Panstruga Petra , Arasteh Keikawus , Rittweger Michael , Wesselmann Hans , Menner Nikolai , Bohr Ulrich , Jessen Heiko , Jessen Arne B. , Schulbin Hubert , Brand Sascha , Gumprecht Jan , Weninger Beate , Hillenbrand Heribert , Karcher Heiko , Fischer Klaus , Schranz Dietmar , Vallée Mathias , Hartikainen Jukka , Grunwald Stephan , Claus Jörg A. , Thomas Claudia , Grimm Roland , Schoor Sarah , Cordes Christiane , Schröder Reinhold , Glaunsinger Tobias , Rausch Michael , Reineke Thomas , Weinberg Gordon , Bruhy Manuel , Köppe Siegfried , Kreckel Peter , Berger Andreas , Lindemann Sinah , Brockmeyer Norbert H. , Potthoff Anja , van Bremen Kathrin , Rockstroh Jürgen , Hower Martin , Bachmann Claudia , Spornraft-Ragaller Petra , Teichmann Dieter , Jensen Björn-Erik Ole , Hüttig Falk , Esser Stefan , Schenk-Westkamp Pia , Haberl Annette , Stephan Christoph , Usadel Susanne , Müller Matthias , Trauth Janina , Chavez-Valladares Alan , Deutschinoff Gerd , Kreft Burkhard , Lange Danica , Degen Olaf , Schäfer Guido , Plettenberg Andreas , Kuhlendahl Frieder , Wiemer Dorothea , Biemann Lavinia , Schewe Knud , Hoffmann Christian , Behrens Georg , Stoll Matthias , Schleenvoigt Benjamin T. , Pletz Mathias W. , Rieke Ansgar , Schneeweiß Stephan , Scholten Stefan , Oette Mark , Arbter Peter A. , Grünewald Thomas , Weidemann Jeannine , Ruck Ines , Claus Bernd , Sprinzl Martin , Galle Peter R. , Ebert Matthias P. , Vogelmann Roger , Bogner Johannes , Hellerer Ulrike , Todorova Antoniya , Traidl-Hoffmann Claudia , Mück Birgit , Pauli Ramona , Spinner Christoph D. , Schneider Jochen , Mück Birgit , Baumann Robert , Schübel Niels , Berning Christiane , Audebert Franz , Trein A. , Schnaitmann E. , Roll Clemens , Marquardt Simone , Härter Georg , Grüner Beate , Güler Cengiz , Rößler Steve , Schürmann Dirk , Warncke Marianne , Rockstroh Jürgen , Wasmuth Jan-Christian , Hass Svetlana , Jensen Björn-Erik Ole , Feind Cecilie , Esser Stefan , Schenk-Westkamp Pia , Stephan Christoph , Haberl Annette , Schott Peter , Plettenberg Andreas , Lorenzen Thore , Kuhlendahl Frieder , Adam Axel , Buhk Thomas , Fenske Stephan , Hansen Stefan , Hoffmann Christian , Sabranski Michael , Schewe Knud , Stellbrink Hans-Jürgen , Radzuweit Dennis , Mainka Alexander , Rickassel Constantin , Degen Olaf , Schäfer Guido , Scheiter Robin , Stoll Matthias , Gerschmann Steve , Beider Renate , Horst Heinz-August , Trautmann Silke , Fätkenheuer Gerd , Vehreschild Jörg Janne , Hamacher Laura , Nicksch Lennart , Bogner Johannes , Sonntag Barbara , Pullen Oliver , Fritzsche Carlos 
Published: February 2024

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.