Clinical outcomes and risk factors for immune recovery and all‐cause mortality in Latin Americans living with HIV with virological success: a retrospective cohort study

• Published in: Journal of the International AIDS Society 2024-03, Vol.27 (3), p.e26214-n/a
• Main Authors: Castillo‐Rozas, Gabriel, Tu, Shengxin, Luz, Paula Mendes, Mejia, Fernando, Sierra‐Madero, Juan, Rouzier, Vanessa, Shepherd, Bryan E., Cortes, Claudia P.
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; Acquired Immunodeficiency Syndrome - drug therapy; AIDS; AIDS (Disease); AIDS research; Anti-HIV Agents - therapeutic use; Antiretroviral agents; Antiretroviral Therapy, Highly Active; Caribbean Region; CD4 Lymphocyte Count; Clinical outcomes; Cohort analysis; Complications and side effects; Disease transmission; Drug therapy; Drug Therapy, Combination; Evaluation; HIV; HIV infection; HIV Infections; Human immunodeficiency virus; Humans; immune reconstitution; Immune response; Immunology; Latin America; Male; morbidity; Mortality; non‐communicable diseases; Observations; Prognosis; Retrospective Studies; Risk Factors; Sexually transmitted diseases; STD; Tuberculosis; Variables; Viral Load
• ISSN: 1758-2652; 1758-2652
• DOI: 10.1002/jia2.26214

Introduction Immune reconstitution following antiretroviral therapy (ART) initiation is crucial to prevent AIDS and non‐AIDS‐related comorbidities. Patients with suppressed viraemia who fail to restore cellular immunity are exposed to an increased risk of morbidity and mortality during long‐term follow‐up, although the underlying mechanisms remain poorly understood. We aim to describe clinical outcomes and factors associated with the worse immune recovery and all‐cause mortality in people living with HIV (PLWH) from Latin America following ART initiation. Methods Retrospective cohort study using the CCASAnet database: PLWH ≥18 years of age at ART initiation using a three drug‐based combination therapy and with medical follow‐up for ≥24 months after ART initiation and undetectable viral load were included. Patients were divided into four immune recovery groups based on rounded quartiles of increase in CD4 T‐cell count at 2 years of treatment (350 cells/mm3). Primary outcomes included all‐cause mortality, AIDS‐defining events and non‐communicable diseases that occurred >2 years after ART initiation. Factors associated with an increase in CD4 T‐cell count at 2 years of treatment were evaluated using a cumulative probability model with a logit link. Results In our cohort of 4496 Latin American PLWH, we found that patients with the lowest CD4 increase (