scholarly journals Estimates of the Time From Seroconversion to Antiretroviral Therapy Initiation Among People Newly Diagnosed With Human Immunodeficiency Virus From 2006 to 2015, New York City

2019 ◽  
Vol 71 (8) ◽  
pp. e308-e315
Author(s):  
McKaylee M Robertson ◽  
Sarah L Braunstein ◽  
Donald R Hoover ◽  
Sheng Li ◽  
Denis Nash
Keyword(s):  
Human Immunodeficiency Virus ◽  
Antiretroviral Therapy ◽  
Hiv Testing ◽  
Mixed Model ◽  
Linear Mixed Model ◽  
Population Based ◽  
Cd4 Count ◽  
Hiv Diagnosis ◽  
Art Initiation ◽  
Immunodeficiency Virus

Abstract Background We estimated the time from human immunodeficiency virus (HIV) seroconversion to antiretroviral therapy (ART) initiation during an era of expanding HIV testing and treatment efforts. Methods Applying CD4 depletion parameters from seroconverter cohort data to our population-based sample, we related the square root of the first pretreatment CD4 count to time of seroconversion through a linear mixed model and estimated the time from seroconversion. Results Among 28 162 people diagnosed with HIV during 2006–2015, 89% initiated ART by June 2017. The median CD4 count at diagnosis increased from 326 (interquartile range [IQR], 132–504) cells/µL to 390 (IQR, 216–571) cells/µL from 2006 to 2015. The median time from estimated seroconversion to ART initiation decreased by 42% from 6.4 (IQR, 3.3–11.4) years in 2006 to 3.7 (IQR, 0.5–8.3) years in 2015. The time from estimated seroconversion to diagnosis decreased by 28%, from a median of 4.6 (IQR, 0.5–10.5) years to 3.3 (IQR, 0–8.1) years from 2006 to 2015, and the time from diagnosis to ART initiation reduced by 60%, from a median of 0.5 (IQR, 0.2–2.1) years to 0.2 (IQR, 0.1–0.3) years from 2006 to 2015. Conclusions The estimated time from seroconversion to ART initiation was reduced in tandem with expanded HIV testing and treatment efforts. While the time from diagnosis to ART initiation decreased to 0.2 years, the time from seroconversion to diagnosis was 3.3 years among people diagnosed in 2015, highlighting the need for more effective strategies for earlier HIV diagnosis.

scholarly journals Decreased Time From Human Immunodeficiency Virus Diagnosis to Care, Antiretroviral Therapy Initiation, and Virologic Suppression during the Citywide RAPID Initiative in San Francisco

2020 ◽  
Author(s):  
Oliver Bacon ◽  
Jennie Chin ◽  
Stephanie E Cohen ◽  
Nancy A Hessol ◽  
Darpun Sachdev ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Antiretroviral Therapy ◽  
San Francisco ◽  
Virologic Suppression ◽  
Hiv Diagnosis ◽  
Virus Diagnosis ◽  
Hiv Surveillance ◽  
Art Initiation ◽  
Care Visit ◽  
Immunodeficiency Virus

Abstract Background Early virologic suppression (VS) after human immunodeficiency virus (HIV) infection improves individual health outcomes and decreases onward transmission. In San Francisco, immediate antiretroviral therapy (ART) at HIV diagnosis was piloted in 2013–2014 and expanded citywide in 2015 in a rapid start initiative to link all new diagnoses to care within 5 days and start ART at the first care visit. Methods HIV providers and linkage navigators were trained on a rapid start protocol with sites caring for vulnerable populations prioritized. Dates of HIV diagnosis, first care visit, ART initiation, and VS were abstracted from the San Francisco Department of Public Health HIV surveillance registry. Results During 2013–2017, among 1354 new HIV diagnoses in San Francisco, median days from diagnosis to first VS decreased from 145 to 76 (48%; P < .0001) and from first care visit to ART initiation decreased from 28 to 1 (96%; P < .0001). By 2017, 28% of new diagnoses had a rapid start, which was independently associated with Latinx ethnicity (AOR, 1.73; 95% CI, 1.15–2.60) and recent year of diagnosis (2017; AOR, 16.84; 95% CI, 8.03–35.33). Persons with a rapid ART start were more likely to be virologically suppressed within 12 months of diagnosis than those with a non-rapid start (RR, 1.17; 95% CI, 1.10–1.24). Conclusions During a multisector initiative to optimize ART initiation, median time from diagnosis to VS decreased by nearly half. Immediate ART at care initiation was achieved across many, but not all, populations, and was associated with improved suppression rates.

scholarly journals Human Immunodeficiency Virus Infection Newly Diagnosed at Autopsy in New York City, 2008–2012

2015 ◽  
Vol 2 (4) ◽  
Author(s):  
Chitra Ramaswamy ◽  
Tanya M. Ellman ◽  
Julie Myers ◽  
Ann Madsen ◽  
Kent Sepkowitz ◽  
...  
Keyword(s):  
New York ◽  
Human Immunodeficiency Virus ◽  
New York City ◽  
Hiv Testing ◽  
York City ◽  
Population Based ◽  
Medical Examiner ◽  
Newly Diagnosed ◽  
Hiv Diagnosis ◽  
Immunodeficiency Virus

Abstract Background.  Studying the most extreme example of late diagnosis, new HIV diagnoses after death, may be instructive to HIV testing efforts. Using the results of routine HIV testing of autopsies performed by the Office of Chief Medical Examiner (OCME), we identified new HIV diagnoses after death in New York City (NYC) from 2008 to 2012. Methods.  Population-based registries for HIV and deaths were linked to identify decedents not known to be HIV-infected before death. Multivariable logistic regression models were constructed to determine correlates of a new HIV diagnosis after death among all persons newly diagnosed with HIV and among all HIV-infected decedents receiving an OCME autopsy. Results.  Of 264 893 deaths, 24 426 (9.2%) were autopsied by the NYC OCME. Of these, 1623 (6.6%) were infected with HIV, including 142 (8.8%) with a new HIV diagnosis at autopsy. This represents 0.8% (142 of 18 542) of all new HIV diagnoses during the 5-year period. Decedents newly diagnosed with HIV at OCME autopsy were predominantly male (73.9%), aged 13–64 years (85.9%), non-white (85.2%), unmarried (81.7%), less than college educated (83.8%), and residents of an impoverished neighborhood (62.0%). Of all HIV-infected OCME decedents aged ≥65 years (n = 71), 22.0% were diagnosed at autopsy. The strongest independent correlate of new HIV diagnosis at autopsy in both multivariable models was age ≥65 years. Conclusions.  Human immunodeficiency virus diagnoses first made after death are rare, but, when observed, these diagnoses are more commonly found among persons ≥65 years, suggesting that despite highly visible efforts to promote HIV testing community-wide, timely diagnosis among older adults living in impoverished, high-prevalence neighborhoods may require additional strategies.

scholarly journals Myocardial Steatosis Among Antiretroviral Therapy–Treated People With Human Immunodeficiency Virus Participating in the REPRIEVE Trial

2020 ◽  
Vol 222 (Supplement_1) ◽  
pp. S63-S69
Author(s):  
Tomas G Neilan ◽  
Kim-Lien Nguyen ◽  
Vlad G Zaha ◽  
Kara W Chew ◽  
Leavitt Morrison ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Human Immunodeficiency Virus ◽  
Antiretroviral Therapy ◽  
Cd4 Count ◽  
Resonance Spectroscopy ◽  
Vascular Events ◽  
Immunodeficiency Virus ◽  
History Of ◽  
Myocardial Steatosis

Abstract Background People with human immunodeficiency virus (PWH) face increased risks for heart failure and adverse heart failure outcomes. Myocardial steatosis predisposes to diastolic dysfunction, a heart failure precursor. We aimed to characterize myocardial steatosis and associated potential risk factors among a subset of the Randomized Trial to Prevent Vascular Events in HIV (REPRIEVE) participants. Methods Eighty-two PWH without known heart failure successfully underwent cardiovascular magnetic resonance spectroscopy, yielding data on intramyocardial triglyceride (IMTG) content (a continuous marker for myocardial steatosis extent). Logistic regression models were applied to investigate associations between select clinical characteristics and odds of increased or markedly increased IMTG content. Results Median (Q1, Q3) IMTG content was 0.59% (0.28%, 1.15%). IMTG content was increased (> 0.5%) among 52% and markedly increased (> 1.5%) among 22% of participants. Parameters associated with increased IMTG content included age (P = .013), body mass index (BMI) ≥ 25 kg/m2 (P = .055), history of intravenous drug use (IVDU) (P = .033), and nadir CD4 count < 350 cells/mm³ (P = .055). Age and BMI ≥ 25 kg/m2 were additionally associated with increased odds of markedly increased IMTG content (P = .049 and P = .046, respectively). Conclusions A substantial proportion of antiretroviral therapy–treated PWH exhibited myocardial steatosis. Age, BMI ≥ 25 kg/m2, low nadir CD4 count, and history of IVDU emerged as possible risk factors for myocardial steatosis in this group. Clinical Trials Registration NCT02344290; NCT03238755.

scholarly journals Timing of Antiretroviral Therapy Initiation and Risk of Cancer Among Persons Living With Human Immunodeficiency Virus

2020 ◽  
Author(s):  
Michael J Silverberg ◽  
Wendy Leyden ◽  
Raúl U Hernández-Ramírez ◽  
Li Qin ◽  
Haiqun Lin ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Antiretroviral Therapy ◽  
Kaposi Sarcoma ◽  
Risk Difference ◽  
Right Censoring ◽  
Transmission Risk ◽  
Adjusted Risk ◽  
Art Initiation ◽  
Immunodeficiency Virus ◽  
Risk Of Cancer

Abstract Background Persons living with human immunodeficiency virus (HIV; PLWH) experience a high burden of cancer. It remains unknown which cancer types are reduced in PLWH with earlier initiation of antiretroviral therapy (ART). Methods We evaluated AIDS-free, ART-naive PLWH during 1996–2014 from 22 cohorts participating in the North American AIDS Cohort Collaboration on Research and Design. PLWH were followed from first observed CD4 of 350–500 cells/µL (baseline) until incident cancer, death, lost-to-follow-up, or December 2014. Outcomes included 6 cancer groups and 5 individual cancers that were confirmed by chart review or cancer registry linkage. We evaluated the effect of earlier (in the first 6 months after baseline) versus deferred ART initiation on cancer risk. Marginal structural models were used with inverse probability weighting to account for time-dependent confounding and informative right-censoring, with weights informed by subject’s age, sex, cohort, baseline year, race/ethnicity, HIV transmission risk, smoking, viral hepatitis, CD4, and AIDS diagnoses. Results Protective results for earlier ART were found for any cancer (adjusted hazard ratio [HR] 0.57; 95% confidence interval [CI], .37–.86), AIDS-defining cancers (HR 0.23; 95% CI, .11–.49), any virus-related cancer (HR 0.30; 95% CI, .16–.54), Kaposi sarcoma (HR 0.25; 95% CI, .10–.61), and non-Hodgkin lymphoma (HR 0.22; 95% CI, .06–.73). By 15 years, there was also an observed reduced risk with earlier ART for virus-related NADCs (0.6% vs 2.3%; adjusted risk difference −1.6; 95% CI, −2.8, −.5). Conclusions Earlier ART initiation has potential to reduce the burden of virus-related cancers in PLWH but not non-AIDS-defining cancers (NADCs) without known or suspected viral etiology.

scholarly journals Missed Opportunities for Human Immunodeficiency Virus (HIV) Testing During Injection Drug Use–Related Healthcare Encounters Among a Cohort of Persons Who Inject Drugs With HIV Diagnosed During an Outbreak—Cincinnati/Northern Kentucky, 2017–2018

2020 ◽  
Author(s):  
Nathan W Furukawa ◽  
Erin F Blau ◽  
Zach Reau ◽  
David Carlson ◽  
Zachary D Raney ◽  
...  
Keyword(s):  
Emergency Department ◽  
Human Immunodeficiency Virus ◽  
Drug Use ◽  
Hiv Testing ◽  
Injection Drug Use ◽  
Injection Drug ◽  
Hiv Diagnosis ◽  
Persons Who Inject Drugs ◽  
Missed Opportunities ◽  
Immunodeficiency Virus

Abstract Background Persons who inject drugs (PWID) have frequent healthcare encounters related to their injection drug use (IDU) but are often not tested for human immunodeficiency virus (HIV). We sought to quantify missed opportunities for HIV testing during an HIV outbreak among PWID. Methods PWID with HIV diagnosed in 5 Cincinnati/Northern Kentucky counties during January 2017–September 2018 who had ≥1 encounter 12 months prior to HIV diagnosis in 1 of 2 Cincinnati/Northern Kentucky area healthcare systems were included in the analysis. HIV testing and encounter data were abstracted from electronic health records. A missed opportunity for HIV testing was defined as an encounter for an IDU-related condition where an HIV test was not performed and had not been performed in the prior 12 months. Results Among 109 PWID with HIV diagnosed who had ≥1 healthcare encounter, 75 (68.8%) had ≥1 IDU-related encounters in the 12 months before HIV diagnosis. These 75 PWID had 169 IDU-related encounters of which 86 (50.9%) were missed opportunities for HIV testing and occurred among 46 (42.2%) PWID. Most IDU-related encounters occurred in the emergency department (118/169; 69.8%). Using multivariable generalized estimating equations, HIV testing was more likely in inpatient compared with emergency department encounters (adjusted relative risk [RR], 2.72; 95% confidence interval [CI], 1.70–4.33) and at the healthcare system receiving funding for emergency department HIV testing (adjusted RR, 1.76; 95% CI, 1.10–2.82). Conclusions PWID have frequent IDU-related encounters in emergency departments. Enhanced HIV screening of PWID in these settings can facilitate earlier diagnosis and improve outbreak response.

scholarly journals Continuous Prophylactic Antiretrovirals/Antiretroviral Therapy Since Birth Reduces Seeding and Persistence of the Viral Reservoir in Children Vertically Infected With Human Immunodeficiency Virus

2020 ◽  
Author(s):  
Marta Massanella ◽  
Thanyawee Puthanakit ◽  
Louise Leyre ◽  
Thidarat Jupimai ◽  
Panadda Sawangsinth ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Antiretroviral Therapy ◽  
Cross Sectional Study ◽  
Viral Reservoir ◽  
Cross Sectional ◽  
Hiv Reservoir ◽  
Hiv Dna ◽  
Art Initiation ◽  
Immunodeficiency Virus ◽  
Infected Cells

Abstract Background Early antiretroviral therapy (ART) restricts the size of the human immunodeficiency virus (HIV) reservoir in infants. However, whether antiretroviral (ARV) prophylaxis given to exposed vertically infected children exerts similar effects remains unknown. Methods We measured total and integrated HIV DNA, as well as the frequency of CD4 T cells producing multiply spliced RNA (msRNA) after stimulation (inducible reservoir) in vertically infected Thai infants. Eighty-five infants were followed longitudinally for up to 3 years. We compared the size of the reservoir in children who received continuous ARV prophylaxis since birth vs those who never received or discontinued prophylaxis before initiating ART. We used samples from a cross-sectional cohort of 37 Thai children who had initiated ART within 6 months of life to validate our findings. Results Before ART, levels of HIV DNA and the frequencies of cells producing msRNA were significantly lower in infants who received continuous ARV prophylaxis since birth compared to those in whom ARV prophylaxis was discontinued or never initiated (P < .020 and P < .001, respectively). Upon ART initiation, total and integrated HIV DNA levels decayed significantly in both groups (P < .01 in all cases). Interestingly, the initial differences in the frequencies of infected cells persisted during 3 years on ART. The beneficial effect of prophylaxis on the size of the HIV reservoir was confirmed in the cross-sectional study. Importantly, no differences were observed between children who discontinued prophylactic ARVs before starting ART and those who delayed ART initiation without receiving prior prophylaxis. Conclusions Neonatal ARV prophylaxis with direct transition to ART durably limits the size of the HIV reservoir.

scholarly journals Antiretroviral Therapy Initiation Is Associated With Decreased Visceral and Subcutaneous Adipose Tissue Density in People Living With Human Immunodeficiency Virus

2020 ◽  
Author(s):  
Paula Debroy ◽  
Jordan E Lake ◽  
Carlee Moser ◽  
Maxine Olefsky ◽  
Kristine M Erlandson ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Human Immunodeficiency Virus ◽  
Adipose Tissue ◽  
Antiretroviral Therapy ◽  
Hdl Cholesterol ◽  
Cd4 T Cell ◽  
Art Initiation ◽  
Immunodeficiency Virus ◽  
Hiv 1 ◽  
Cd4 T Cell Count

Abstract Background Adipose tissue (AT) alterations are common in people living with human immunodeficiency virus (PLWH). Decreases in AT density suggest disrupted adipocyte function/hypertrophy. We assessed changes in AT density after antiretroviral therapy (ART) initiation and associations with immunometabolic parameters. Methods In a prospective randomized clinical trial of ART initiation, L4–L5 abdominal CT scans measured subcutaneous AT (SAT) and visceral AT (VAT) area and density in treatment-naive PLWH randomized to tenofovir-emtricitabine plus ritonavir-boosted atazanavir, ritonavir-boosted darunavir, or raltegravir. Linear regression models compared week 0 and week 96 levels, and 96-week changes, in SAT and VAT density (in Hounsfield units [HU]). Spearman correlations assessed relationships between AT density and immunometabolic parameters. Results Of the 228 participants, 89% were male and 44% were white non-Hispanic. Median age was 36 years, baseline HIV-1 RNA was 4.6 log10 copies/mL, and CD4+ T-cell count was 344 cells/μL. Over 96 weeks, SAT and VAT HU decreased significantly in all arms. Less dense week 96 SAT and VAT density correlated with higher high-density lipoprotein (HDL) cholesterol and adiponectin (r = 0.19–0.30) levels and lower interleukin 6, non-HDL cholesterol, triglyceride, leptin, and homeostatic model assessment of insulin resistance (r = −0.23 to −0.68) levels at week 96 after adjusting for baseline CD4+ T-cell count, HIV-1 RNA, and baseline AT area. Conclusions Following virologic suppression, lower SAT and VAT density was associated with greater plasma measures of systemic inflammation, lipid disturbances, and insulin resistance independent of AT area, suggesting that changes in AT density with ART may lead to adverse health outcomes independent of AT quantity. Clinical Trials Registration NCT00851799.

scholarly journals Implications of the human immunodeficiency virus test and treat strategy on antiretroviral treatment uptake and retention outcomes in Cameroon

2019 ◽  
Vol 6 (11) ◽  
pp. 4716
Author(s):  
Rogers A. Awoh ◽  
Halle G. Ekane ◽  
Anastase Dzudie ◽  
Egbe O. Thomas ◽  
Adebola Adedimeji ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Retrospective Chart Review ◽  
Hiv Care ◽  
Retention Data ◽  
Hiv Diagnosis ◽  
Chi Square ◽  
Test And Treat ◽  
Art Initiation ◽  
Hiv Test ◽  
Immunodeficiency Virus

Background: Success of the human immunodeficiency virus (HIV) test-and-treat (T&T) strategy requires high antiretroviral (ART) uptake and retention. However, low ART uptake and retention continue to be reported in ART programs. This study assessed ART uptake and retention outcomes of the HIV T&T strategy in three HIV clinics in Cameroon.Methods: A retrospective chart review was done for 423 patients who initiated HIV care within a period of three months prior to the implementation of the HIV T&T strategy, and for another 423 patients who initiated HIV care within a three-month period following the HIV T&T strategy implementation. For each group, sociodemographic, ART uptake and retention data were collected. Chi square and Student T tests were used to test for differences proportions and means between the two groups at p <0.05 and 95% confidence interval.Results: The mean ages (years) in the pre-T&T and the T&T groups were 39.73 and 39.72, and the proportion of female were 65.85% and 65.08% respectively. ART uptake proportion was higher amongst those enrolled under the T&T strategy (98.08% vs 95.39%, p=0.02). A greater proportion of the patients in the T&T group initiated ART within 2 weeks following HIV diagnosis (55.84% vs 48.17%, p=0.03). However, ART retention at 24th month was lower in the T&T group (78.83% vs. 85.79%, p=0.01).Conclusions: The findings suggest that the T&T strategy is associated with higher ART uptake, earlier ART initiation, and lower ART retention. This underscores a need for strategies to improve ART retention under the HIV T&T guidelines. 

scholarly journals Safety and Effectiveness of Isoniazid Preventive Therapy in Pregnant Women Living with Human Immunodeficiency Virus on Antiretroviral Therapy: An Observational Study Using Linked Population Data

2020 ◽  
Vol 71 (8) ◽  
pp. e351-e358 ◽  
Author(s):  
Emma Kalk ◽  
Alexa Heekes ◽  
Ushma Mehta ◽  
Renee de Waal ◽  
Nisha Jacob ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Antiretroviral Therapy ◽  
Pregnant Women ◽  
Pregnancy Outcomes ◽  
Absolute Risk ◽  
First Trimester ◽  
Preventive Therapy ◽  
Cd4 Count ◽  
Isoniazid Preventive Therapy ◽  
Immunodeficiency Virus

Abstract Background Isoniazid preventive therapy (IPT) is widely used to protect against tuberculosis (TB) in people living with human immunodeficiency virus (HIV). Data on the safety and efficacy of IPT in pregnant women living with HIV (PWLHIV) are mixed. We used an individual-level, population-wide health database to examine associations between antenatal IPT exposure and adverse pregnancy outcomes, maternal TB, all-cause mortality, and liver injury during pregnancy through 12 months postpartum. Methods We used linked routine electronic health data generated in the public sector of the Western Cape, South Africa, to define a cohort of PWLHIV on antiretroviral therapy. Pregnancy outcomes were assessed using logistic regression; for maternal outcomes we applied a proportional hazards model with time-updated IPT exposure. Results Of 43 971 PWLHIV, 16.6% received IPT. Women who received IPT were less likely to experience poor pregnancy outcomes (adjusted odds ratio [aOR], 0.83 [95% confidence interval {CI}, .78–.87]); this association strengthened with IPT started after the first trimester compared with none (aOR, 0.71 [95% CI, .65–.79]) or with first-trimester exposure (aOR, 0.64 [95% CI, .55–.75]). IPT reduced the risk of TB by approximately 30% (aHR, 0.71 [95% CI, .63–.81]; absolute risk difference, 1518/100 000 women). The effect was modified by CD4 cell count with protection conferred if CD4 count was ≤350 cells/μL (aHR, 0.51 [95% CI, .41–.63]) vs 0.93 [95% CI, .76–1.13] for CD4 count &gt;350 cells/µL). Conclusions This analysis of programmatic data is reassuring regarding the safety of antenatal IPT, with the greatest benefits against TB disease observed in women with CD4 count ≤350 cells/μL.

scholarly journals Prevalence and Clinical Outcomes of Poor Immune Response Despite Virologically Suppressive Antiretroviral Therapy Among Children and Adolescents With Human Immunodeficiency Virus in Europe and Thailand: Cohort Study

2019 ◽  
Author(s):  
◽  
Elizabeth Chappell ◽  
Andrew Riordan ◽  
Gonzague Jourdain ◽  
Antoni Soriano-Arandes ◽  
...  
Keyword(s):  
Immune Response ◽  
Human Immunodeficiency Virus ◽  
Antiretroviral Therapy ◽  
Multivariable Analysis ◽  
World Health ◽  
Severe Immunosuppression ◽  
Art Initiation ◽  
Cell Counts ◽  
Increased Risk ◽  
Immunodeficiency Virus

Abstract Background In human immunodeficiency virus (HIV)–positive adults, low CD4 cell counts despite fully suppressed HIV-1 RNA on antiretroviral therapy (ART) have been associated with increased risk of morbidity and mortality. We assessed the prevalence and outcomes of poor immune response (PIR) in children receiving suppressive ART. Methods Sixteen cohorts from the European Pregnancy and Paediatric HIV Cohort Collaboration (EPPICC) contributed data. Children <18 years at ART initiation, with sustained viral suppression (VS) (≤400 copies/mL) for ≥1 year were included. The prevalence of PIR (defined as World Health Organization advanced/severe immunosuppression for age) at 1 year of VS was described. Factors associated with PIR were assessed using logistic regression. Rates of acquired immunodeficiency syndrome (AIDS) or death on suppressive ART were calculated by PIR status. Results Of 2318 children included, median age was 6.4 years and 68% had advanced/severe immunosuppression at ART initiation. At 1 year of VS, 12% had PIR. In multivariable analysis, PIR was associated with older age and worse immunological stage at ART start, hepatitis B coinfection, and residing in Thailand (all P ≤ .03). Rates of AIDS/death (95% confidence interval) per 100 000 person-years were 1052 (547, 2022) among PIR versus 261 (166, 409) among immune responders; rate ratio of 4.04 (1.83, 8.92; P < .001). Conclusions One in eight children in our cohort experienced PIR despite sustained VS. While the overall rate of AIDS/death was low, children with PIR had a 4-fold increase in risk of event as compared with immune responders.

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