O314 Predicting the short-term risk of diabetes in HIV-infected patients in the D:A:D cohort: the D:A:D study group

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Impact of risk factors for specific causes of death in the first and subsequent years of antiretroviral therapy among HIV-infected patients.

BACKGROUND: Patterns of cause-specific mortality in individuals infected with human immunodeficiency virus type 1 (HIV-1) are changing dramatically in the era of antiretroviral therapy (ART). METHODS: Sixteen cohorts from Europe and North America contributed data on adult patients followed from the start of ART. Procedures for coding causes of death were standardized. Estimated hazard ratios (HRs) were adjusted for transmission risk group, sex, age, year of ART initiation, baseline CD4 count, viral load, and AIDS status, before and after the first year of ART. RESULTS: A total of 4237 of 65 121 (6.5%) patients died (median, 4.5 years follow-up). Rates of AIDS death decreased substantially with time since starting ART, but mortality from non-AIDS malignancy increased (rate ratio, 1.04 per year; 95% confidence interval [CI], 1.0-1.1). Higher mortality in men than women during the first year of ART was mostly due to non-AIDS malignancy and liver-related deaths. Associations with age were strongest for cardiovascular disease, heart/vascular, and malignancy deaths. Patients with presumed transmission through injection drug use had higher rates of all causes of death, particularly for liver-related causes (HRs compared with men who have sex with men: 18.1 [95% CI, 6.2-52.7] during the first year of ART and 9.1 [95% CI, 5.8-14.2] thereafter). There was a persistent role of CD4 count at baseline and at 12 months in predicting AIDS, non-AIDS infection, and non-AIDS malignancy deaths. Lack of viral suppression on ART was associated with AIDS, non-AIDS infection, and other causes of death. CONCLUSIONS: Better understanding of patterns of and risk factors for cause-specific mortality in the ART era can aid in development of appropriate care for HIV-infected individuals and inform guidelines for risk factor management

Impact of Risk Factors for Specific Causes of Death in the First and Subsequent Years of Antiretroviral Therapy Among HIV-Infected Patients

Among HIV-infected patients who initiated antiretroviral therapy (ART), patterns of cause-specific death varied by ART duration and were strongly related to age, sex, and transmission risk group. Deaths from non-AIDS malignancies were much more frequent than those from cardiovascular diseas

Major Challenges in clinical management of TB/HIV coinfected patients in Eastern Europe compared with Western Europe and Latin America

Objectives: rates of TB/HIV coinfection and multi-drug resistant (MDR)-TB are increasing in Eastern Europe (EE). We aimed to study clinical characteristics, factors associated with MDR-TB and predicted activity of empiric anti-TB treatment at time of TB diagnosis among TB/HIV coinfected patients in EE, Western Europe (WE) and Latin America (LA). Design and methods: between January 1, 2011, and December 31, 2013, 1413 TB/HIV patients (62 clinics in 19 countries in EE, WE, Southern Europe (SE), and LA) were enrolled. Results: significant differences were observed between EE (N = 844), WE (N = 152), SE (N = 164), and LA (N = 253) in the proportion of patients with a definite TB diagnosis (47%, 71%, 72% and 40%, p<0.0001), MDR-TB (40%, 5%, 3% and 15%, p<0.0001), and use of combination antiretroviral therapy (cART) (17%, 40%, 44% and 35%, p<0.0001). Injecting drug use (adjusted OR (aOR) = 2.03 (95% CI 1.00-4.09), prior anti-TB treatment (3.42 (1.88-6.22)), and living in EE (7.19 (3.28-15.78)) were associated with MDR-TB. Among 585 patients with drug susceptibility test (DST) results, the empiric (i.e. without knowledge of the DST results) anti-TB treatment included ≥3 active drugs in 66% of participants in EE compared with 90-96% in other regions (p<0.0001). Conclusions: in EE, TB/HIV patients were less likely to receive a definite TB diagnosis, more likely to house MDR-TB and commonly received empiric anti-TB treatment with reduced activity. Improved management of TB/HIV patients in EE requires better access to TB diagnostics including DSTs, empiric anti-TB therapy directed at both susceptible and MDR-TB, and more widespread use of cART

Role of immunological and virological parameters in the risk of cancer in persons living with HIV of the ANRS CO3 Aquitaine Cohort

Les cancers représentent une cause importante de morbidité et de mortalité chez les personnes vivant avec le VIH. Ce travail s’est inscrit dans l’étude des déterminants immunologiques et virologiques du risque de cancer au sein de la Cohorte ANRS CO3 Aquitaine. Ces facteurs de risque ont été étudiés à l’aide de modèles de Cox à entrée retardée et variables dépendantes du temps dans deux études de cohorte. Une étude cas-témoins nichée dans la Cohorte Aquitaine a recherché à l’aide de modèles de régression logistique conditionnelle un rôle du cytomégalovirus (CMV) dans le risque de cancer.Entre 1998 et 2006, 4 194 patients ont présenté 251 cancers. Une charge virale >500 copies/mL était un déterminant du risque de cancer classant sida (Risque Relatif [RR] = 3.3, Intervalle de Confiance à 95% [IC] : 2.1–5.2, p 500 cellules/mm3, si besoin à l’aide des traitements antirétroviraux, afin de prévenir le risque de cancer en plus des mesures préventives traditionnelles.Persons living with HIV are at higher risk of malignancies. In addition to traditional determinants, deleterious effects of immunological or virological parameters are speculated in this population. The objective of this thesis was to study immunological and virological risk factors for cancer in the ANRS CO3 Aquitaine Cohort of persons living with HIV. Extended Cox proportional hazard models with delayed entry and time-updated variables were used in two cohort studies, and the role of the cytomegalovirus (CMV) in the risk of cancer was assessed in a nested case control study with conditional logistic regression models.Between 1998 and 2006, 4,194 patients presented 251 cancers. Plasma HIV RNA >500 copies/mL and a CD4 cell count (CD4) <200 cells/mm3 were associated with a higher risk of AIDS-defining cancer: (Hazard Ratio [HR]=3.3, 95% Confidence Interval [CI]: 2.1–5.2, p <0.001) and (HR=6.3, CI: 4.2–9.4, p <0.001), respectively. CD4 <500 was associated with a higher risk of non-AIDS-defining cancer (HR=2.1, CI: 1.4–3.1, p <0.001). Among 2,864 patients who presented 16 hepatocarcinomas, current CD4 <500 was a risk factor for cancer (HR=10.3, CI: 1.3–82.8, p=0.03), but not the cumulative exposure to CD4 <500 preceding the current measurement (p=0.8). Positive plasma CMV DNAemia was not associated with the risk of cancer among 143 cancer cases and 284 control patients (p=0.54).These results suggest that maintaining an undetectable plasma HIV RNA viral load and a CD4 cell count above 500 cells/mm3, if needed by prescribing antiretroviral treatment, should prevent cancer occurrence among HIV-infected patients, additionally to the traditional prevention policie

Role of immunological and virological parameters in the risk of cancer in persons living with HIV of the ANRS CO3 Aquitaine Cohort

Les cancers représentent une cause importante de morbidité et de mortalité chez les personnes vivant avec le VIH. Ce travail s’est inscrit dans l’étude des déterminants immunologiques et virologiques du risque de cancer au sein de la Cohorte ANRS CO3 Aquitaine. Ces facteurs de risque ont été étudiés à l’aide de modèles de Cox à entrée retardée et variables dépendantes du temps dans deux études de cohorte. Une étude cas-témoins nichée dans la Cohorte Aquitaine a recherché à l’aide de modèles de régression logistique conditionnelle un rôle du cytomégalovirus (CMV) dans le risque de cancer.Entre 1998 et 2006, 4 194 patients ont présenté 251 cancers. Une charge virale >500 copies/mL était un déterminant du risque de cancer classant sida (Risque Relatif [RR] = 3.3, Intervalle de Confiance à 95% [IC] : 2.1–5.2, p 500 cellules/mm3, si besoin à l’aide des traitements antirétroviraux, afin de prévenir le risque de cancer en plus des mesures préventives traditionnelles.Persons living with HIV are at higher risk of malignancies. In addition to traditional determinants, deleterious effects of immunological or virological parameters are speculated in this population. The objective of this thesis was to study immunological and virological risk factors for cancer in the ANRS CO3 Aquitaine Cohort of persons living with HIV. Extended Cox proportional hazard models with delayed entry and time-updated variables were used in two cohort studies, and the role of the cytomegalovirus (CMV) in the risk of cancer was assessed in a nested case control study with conditional logistic regression models.Between 1998 and 2006, 4,194 patients presented 251 cancers. Plasma HIV RNA >500 copies/mL and a CD4 cell count (CD4) <200 cells/mm3 were associated with a higher risk of AIDS-defining cancer: (Hazard Ratio [HR]=3.3, 95% Confidence Interval [CI]: 2.1–5.2, p <0.001) and (HR=6.3, CI: 4.2–9.4, p <0.001), respectively. CD4 <500 was associated with a higher risk of non-AIDS-defining cancer (HR=2.1, CI: 1.4–3.1, p <0.001). Among 2,864 patients who presented 16 hepatocarcinomas, current CD4 <500 was a risk factor for cancer (HR=10.3, CI: 1.3–82.8, p=0.03), but not the cumulative exposure to CD4 <500 preceding the current measurement (p=0.8). Positive plasma CMV DNAemia was not associated with the risk of cancer among 143 cancer cases and 284 control patients (p=0.54).These results suggest that maintaining an undetectable plasma HIV RNA viral load and a CD4 cell count above 500 cells/mm3, if needed by prescribing antiretroviral treatment, should prevent cancer occurrence among HIV-infected patients, additionally to the traditional prevention policie

Etude des déterminants immunologiques et virologiques du risque de cancer chez les personnes vivant avec le VIH

Les cancers représentent une cause importante de morbidité et de mortalité chez les personnes vivant avec le VIH. Ce travail s est inscrit dans l étude des déterminants immunologiques et virologiques du risque de cancer au sein de la Cohorte ANRS CO3 Aquitaine. Ces facteurs de risque ont été étudiés à l aide de modèles de Cox à entrée retardée et variables dépendantes du temps dans deux études de cohorte. Une étude cas-témoins nichée dans la Cohorte Aquitaine a recherché à l aide de modèles de régression logistique conditionnelle un rôle du cytomégalovirus (CMV) dans le risque de cancer.Entre 1998 et 2006, 4 194 patients ont présenté 251 cancers. Une charge virale >500 copies/mL était un déterminant du risque de cancer classant sida (Risque Relatif [RR] = 3.3, Intervalle de Confiance à 95% [IC] : 2.1 5.2, p 500 cellules/mm3, si besoin à l aide des traitements antirétroviraux, afin de prévenir le risque de cancer en plus des mesures préventives traditionnelles.Persons living with HIV are at higher risk of malignancies. In addition to traditional determinants, deleterious effects of immunological or virological parameters are speculated in this population. The objective of this thesis was to study immunological and virological risk factors for cancer in the ANRS CO3 Aquitaine Cohort of persons living with HIV. Extended Cox proportional hazard models with delayed entry and time-updated variables were used in two cohort studies, and the role of the cytomegalovirus (CMV) in the risk of cancer was assessed in a nested case control study with conditional logistic regression models.Between 1998 and 2006, 4,194 patients presented 251 cancers. Plasma HIV RNA >500 copies/mL and a CD4 cell count (CD4) <200 cells/mm3 were associated with a higher risk of AIDS-defining cancer: (Hazard Ratio [HR]=3.3, 95% Confidence Interval [CI]: 2.1 5.2, p <0.001) and (HR=6.3, CI: 4.2 9.4, p <0.001), respectively. CD4 <500 was associated with a higher risk of non-AIDS-defining cancer (HR=2.1, CI: 1.4 3.1, p <0.001). Among 2,864 patients who presented 16 hepatocarcinomas, current CD4 <500 was a risk factor for cancer (HR=10.3, CI: 1.3 82.8, p=0.03), but not the cumulative exposure to CD4 <500 preceding the current measurement (p=0.8). Positive plasma CMV DNAemia was not associated with the risk of cancer among 143 cancer cases and 284 control patients (p=0.54).These results suggest that maintaining an undetectable plasma HIV RNA viral load and a CD4 cell count above 500 cells/mm3, if needed by prescribing antiretroviral treatment, should prevent cancer occurrence among HIV-infected patients, additionally to the traditional prevention policiesBORDEAUX2-Bib. électronique (335229905) / SudocSudocFranceF

Infections bactériennes et fongiques au sein de la cohorte ANRS CO3 Aquitaine de personnes vivant avec le VIH (critères de validation et descriptif)

BORDEAUX2-BU Santé (330632101) / SudocSudocFranceF

Vaccination anti-amarile et immunosuppression

BORDEAUX2-BU Santé (330632101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF