AIDS and non-AIDS severe morbidity associated with hospitalizations among HIV-infected patients in two regions with universal access to care and antiretroviral therapy, France and Brazil, 2000-2008: hospital-based cohort studies

Collaborators: Dabis F, Bonnet F, Breilh D, Dabis F, Dupon M, Chêne G, Fleury H, Malvy D, Mercié P, Pellegrin I, Morlat P, Neau D, Pellegrin JL, Thiébaut R, Bouchet S, Gaborieau V, Lacoste D, Tchamgoué S, Wittkop L, Chêne G, Dabis F, Thiébaut R, Bruyand M, Lawson-Ayayi S, Wittkop L, Morlat P, Bonnet F, Bernard N, Hessamfar M, Lacoste D, Vandenhende MA, Dupon M, Dauchy FA, Dutronc H, Mercié P, Duffau P, Schmeltz JR, Malvy D, Pistone T, Receveur MC, Neau D, Cazanave C, Ochoa A, Vareil MO, Pellegrin JL, Viallard JF, Greib C, Lazaro E, Fleury H, Lafon ME, Reigadas S, Trimoulet P, Breilh D, Molimard M, Bouchet S, Titier K, Moreau JF, Pellegrin I, Haramburu F, Miremont-Salamé G, Dupont A, Gerard Y, Caunègre L, André K, Bonnal F, Farbos S, Gemain MC, Ceccaldi J, Caubet O, Tchamgoué S, De Witte S, Courtault C, Monlun E, Gaborieau V, Lataste P, Meraud JP, Chossat I, Blaizeau MJ, Bruyand M, Conte V, Decoin M, Delaune J, Delveaux S, Diarra F, D'Ivernois C, Frosch A, Geffard S, Hanappier C, Lawson-Ayayi S, Lenaud E, Leleux O, Le Marec F, Leray J, Louis I, Palmer G, Pougetoux A, Sicard X, Touchard D, Uwamaliya-Nziyumvira B.Submitted by Fábio Marques ([email protected]) on 2018-07-09T15:05:09Z No. of bitstreams: 1 AIDS and non-AIDS severe morbidity associated with hospitalizations_Paula_Luz_etal_INI_Lapclin_2014.pdf: 256510 bytes, checksum: dc71d13277ec68116fe84549b7e98587 (MD5)Approved for entry into archive by Regina Costa ([email protected]) on 2018-10-03T19:21:11Z (GMT) No. of bitstreams: 1 AIDS and non-AIDS severe morbidity associated with hospitalizations_Paula_Luz_etal_INI_Lapclin_2014.pdf: 256510 bytes, checksum: dc71d13277ec68116fe84549b7e98587 (MD5)Made available in DSpace on 2018-10-03T19:21:11Z (GMT). No. of bitstreams: 1 AIDS and non-AIDS severe morbidity associated with hospitalizations_Paula_Luz_etal_INI_Lapclin_2014.pdf: 256510 bytes, checksum: dc71d13277ec68116fe84549b7e98587 (MD5) Previous issue date: 2014Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil.Centre Hospitalier Universitaire de Bordeaux. Pôle de Santé Publique. COREVIH Aquitaine. France / INSERM. ISPED. Centre Inserm U897- Epidemiologie-Biostatistique & CIC-EC7. France.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil.Centre Hospitalier Universitaire de Bordeaux. Pôle de Santé Publique. COREVIH Aquitaine. France / INSERM. ISPED. Centre Inserm U897- Epidemiologie-Biostatistique & CIC-EC7. France.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil.Centre Hospitalier Universitaire de Bordeaux. Pôle de Santé Publique. COREVIH Aquitaine. France / INSERM. ISPED. Centre Inserm U897- Epidemiologie-Biostatistique & CIC-EC7. France.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil.Centre Hospitalier Universitaire de Bordeaux. Hôpital Haut-Lévèque. Bordeaux, France.Centre Hospitalier Universitaire de Bordeaux. Hôpital Pellegrin. Bordeaux, France.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil.Centre Hospitalier Universitaire de Bordeaux. Pôle de Santé Publique. COREVIH Aquitaine. France / INSERM. ISPED. Centre Inserm U897- Epidemiologie-Biostatistique & CIC-EC7. France.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil.Centre Hospitalier Universitaire de Bordeaux. Pôle de Santé Publique. COREVIH Aquitaine. France / INSERM. ISPED. Centre Inserm U897- Epidemiologie-Biostatistique & CIC-EC7. France.Background: In high-income settings, the spectrum of morbidity and mortality experienced by Human Immunodeficiency Virus (HIV)-infected individuals receiving combination antiretroviral therapy (cART) has switched from predominantly AIDS-related to non-AIDS-related conditions. In the context of universal access to care, we evaluated whether that shift would apply in Brazil, a middle-income country with universal access to treatment, as compared to France. Methods: Two hospital-based cohorts of HIV-infected individuals were used for this analysis: the ANRS CO3 Aquitaine Cohort in South Western France and the Evandro Chagas Research Institute (IPEC) Cohort of the Oswaldo Cruz Foundation in Rio de Janeiro, Brazil. Severe morbid events (AIDS- and non-AIDS-related) were defined as all clinical diagnoses associated with a hospitalization of ≥48 hours. Trends in the incidence rate of events and their determinants were estimated while adjusting for within-subject correlation using generalized estimating equations models with an auto-regressive correlation structure and robust standard errors. Result: Between January 2000 and December 2008, 7812 adult patients were followed for a total of 41,668 personyears (PY) of follow-up. Throughout the study period, 90% of the patients were treated with cART. The annual incidence rate of AIDS and non-AIDS events, and of deaths significantly decreased over the years, from 6.2, 21.1, and 1.9 AIDS, non-AIDS events, and deaths per 100 PY in 2000 to 4.3, 14.9, and 1.5/100 PY in 2008. The annual incidence rates of non-AIDS events surpassed that of AIDS-events during the entire study period. High CD4 cell counts were associated with a lower incidence rate of AIDS and non-AIDS events as well as with lower rates of specific non-AIDS events, such as bacterial, hepatic, viral, neurological, and cardiovascular conditions. Adjusted analysis showed that severe morbidity was associated with lower CD4 counts and higher plasma HIV RNAs but not with setting (IPEC versus Aquitaine). Conclusions: As information on severe morbidities for HIV-infected patients remain scarce, data on hospitalizations are valuable to identify priorities for case management and to improve the quality of life of patients with a chronic disease requiring life-long treatment. Immune restoration is highly effective in reducing AIDS and non-AIDS severe morbid events irrespective of the setting

Supplementary Material for: Absence of Decline of Kidney Function in Human Immunodeficiency Virus-Infected Patients Under Routine Clinical Management

<p><b><i>Background:</i></b> Since the introduction of antiretroviral therapy (ART), human immunodeficiency virus (HIV)-infected patients have a drastically improved prognosis but at the same time they are also more affected by non-HIV related complications, such as chronic kidney disease. The objective of our study was to investigate the effect of proteinuria and tenofovir (TDF)-containing ART regimens on the temporal evolution of estimated glomerular filtration rate (eGFR). <b><i>Methods:</i></b> Between April 2008 and October 2012, we enrolled 395 patients with a complete renal evaluation among patients from the ANRS C03 Aquitaine cohort, a prospective hospital-based cohort of HIV-1-infected patients under routine clinical management in southwestern France. eGFR was estimated at each patient follow-up visit. A linear mixed model was used to analyze eGFR dynamics, accounting for change in TDF by modeling eGFR trajectory according to treatment periods. <b><i>Results:</i></b> At inclusion, 56.7% of patients were treated with TDF-containing ART regimens; prevalence of glomerular and tubular proteinuria was 7.9 and 10.8% respectively. A 1-year increase of cumulative exposure to TDF was significantly associated with a mean eGFR decrease of 1.27 mL/min/1.73 m² (95% CI [-2.14 to -0.41]). Only a urine protein to creatinine ratio >100 mg/mmol and/or a urine albumin to creatinine ratio >70 mg/mmol were associated with eGFR trajectory (mean slope 6.18 mL/min/1.73 m² per year; 95% CI [2.71 to 9.65]), whereas TDF use was not associated with such eGFR temporal evolution. <b><i>Conclusion:</i></b> Decline in kidney function is limited under routine clinical management with monitoring of renal function and interventions including decision to continue or discontinue TDF.</p