Mortality and immunovirological outcomes in patients with advanced HIV disease on their first antiretroviral treatment: differential impact of antiretroviral regimens
Authors: Burgos Joaquin , Moreno-Fornés Sergio , Reyes-Urueña Juliana , Bruguera Andreu , Martín-Iguacel Raquel , Raventos Berta , Llibre Josep M , Imaz Arkaitz , Peraire Joaquim , Orti Amat-Joaquim , Dalmau David , Casabona Jordi , Miró Josep M , Falcó Vicenç ,   the PISCIS study group, Muntada Esteve , Esteve Anna , Fanjul Francisco , Falcó Vicenç , Knobel Hernando , Mallolas Josep , Tiraboschi Juan , Curran Adrià , Burgos Joaquín , Revollo Boris , Gracia Maria , Gutierrez Maria Del Mar , Murillas Javier , Homar Francisco , Fernández-Montero Jose V , González Eva , Peraire Joaquim , Force Lluís , Leon Elena , Hortos Miquel , Vilaró Ingrid , Orti Amat , Dalmau David , Jaen Àngels , Lazzari Elisa De , Berrocal Leire , Rodríguez Lucía , Gargoulas Freya , Vanrell Toni , Carlos Jose , Vilà Josep , Martínez Marina , Morell Bibiana , Tamayo Maribel , Palacio Jorge , Ambrosioni Juan , Laguno Montse , Martínez-Rebollar María , Blanco José L , Garcia Felipe , Torres Berta , Mora Lorena de la , Inciarte Alexy , Ugarte Ainoa , Chivite Iván , González-Cordon Ana , Leal Lorna , Jou Antoni , Negredo Eugènia , Saumoy Maria , Silva Ana , Scévola Sofia , Suanzes Paula , Alvarez Patricia , Mur Isabel , Jaume Melchor Riera , García-Gasalla Mercedes , Ribas Maria À , Campins Antoni A , Peñaranda María , Martin María L , Haydee Helem , Calzado Sònia , Cervantes Manel , Navarro Marta , Payeras Antoni , Cifuentes Carmen , Villoslada Aroa , Sorní Patrícia , Molero Marta , Abdulghani Nadia , Comella Thaïs , Sola Rocio , Vargas Montserrat , Viladés Consuleo , Martí Anna , Yeregui Elena , Rull Anna , Barrufet Pilar , Arbones Laia , Chamarro Elena , Escrig Cristina , Cairó Mireia , Martinez-Lacasa Xavier , Font Roser , Macorigh Lizza , Hernández Juanse 
Published: October 2022

Abstract

Objectives
To assess the clinical and immunovirological outcomes among naive patients with advanced HIV presentation starting an antiretroviral regimen in real-life settings.

Methods
This was a multicentre, prospective cohort study. We included all treatment-naive adults with advanced HIV disease (CD4+ T cell count &lt; 200 cells/mm3or presence of an AIDS-defining illness) who started therapy between 2010 and 2020. The main outcomes were mortality, virological effectiveness (percentage of patients with viral load of ≤50 copies/mL) and immune restoration (percentage of patients with CD4+ T cell count above 350 cells/mm3). Competing risk analysis and Cox proportional models were performed. A propensity score-matching procedure was applied to assess the impact of the antiretroviral regimen.

Results
We included 1594 patients with advanced HIV disease [median CD4+T cell count of 81 cells/mm3and 371 (23.3%) with AIDS-defining illness] and with a median follow-up of 4.44 years. The most common ART used was an integrase strand transfer inhibitor (InSTI) regimen (46.9%), followed by PI (35.7%) and NNRTI (17.4%), with adjusted mortality rates at 3 years of 3.1% (95% CI 1.8%–4.3%), 4.7% (95% CI 2.2%–7.1%) and 7.6% (95% CI 5.4%–9.7%) (P = 0.001), respectively. Factors associated with increased mortality included older age and history of injection drug use, whilst treatment with an InSTI regimen was a protective factor [HR 0.5 (95% CI 0.3–0.9)]. A sensitivity analysis with propensity score procedure confirms these results. Patients who started an InSTI achieved viral suppression and CD4+ T cell count above 350 cells/mm3significantly earlier.

Conclusions
In this large real-life prospective cohort study, a significant lower mortality, earlier viral suppression and earlier immune reconstitution were observed among patients with advanced HIV disease treated with InSTIs.