Journal ArticleDOI
Mortality in well controlled HIV in the continuous antiretroviral therapy arms of the SMART and ESPRIT trials compared with the general population.
Alison Rodger,Rebecca Lodwick,Mauro Schechter,Steven G. Deeks,Janaki Amin,Richard Gilson,Roger Paredes,Elzbieta Bakowska,Frederik Neess Engsig,Andrew N. Phillips +9 more
TLDR
In HIV-infected individuals on ART, with a recent undetectable viral load, who maintained or had recovery of CD4+ cell counts to at least 500 cells/&mgr;l, there is no evidence for a raised risk of death compared with the general population.Abstract:
Background: Due to the success of antiretroviral therapy (ART), it is relevant to ask whether death rates in optimally treated HIV are higher than the general population. The objective was to compare mortality rates in well controlled HIV-infected adults in the SMART and ESPRIT clinical trials with the general population. Methods: Non-IDUs aged 20-70 years from the continuous ART control arms of ESPRIT and SMART were included if the person had both low HIV plasma viral loads (≤400 copies/ml SMART, ≤500 copies/ml ESPRIT) and high CD4 T-cell counts (≥350 cells/ml) at any time in the past 6 months. Standardized mortality ratios (SMRs) were calculated by comparing death rates with the Human Mortality Database. Results: Three thousand, two hundred and eighty individuals [665 (20%) women], median age 43 years, contributed 12 357 person-years of follow-up. Sixty-two deaths occurred during follow up. Commonest cause of death was cardiovascular disease (CVD) or sudden death (19, 31%), followed by non-AIDS malignancy (12, 19%). Only two deaths (3%) were AIDS-related. Mortality rate was increased compared with the general population with a CD4 cell count between 350 and 499 cells/ml [SMR 1.77, 95% confidence interval (CI) 1.17-2.55]. No evidence for increased mortality was seen with CD4 cell counts greater than 500 cells/ml (SMR 1.00, 95% CI 0.69-1.40). Conclusion: In HIV-infected individuals on ART, with a recent undetectable viral load, who maintained or had recovery of CD4 cell counts to at least 500 cells/ml, we identified no evidence for a raised risk of death compared with the general population.read more
Citations
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Antiretroviral Therapy for the Prevention of HIV-1 Transmission
Myron S. Cohen,Ying Q. Chen,Marybeth McCauley,Theresa Gamble,Mina C. Hosseinipour,Nagalingeswaran Kumarasamy,James Hakim,Johnstone Kumwenda,Beatriz Grinsztejn,José Henrique Pilotto,Sheela Godbole,Suwat Chariyalertsak,Breno Santos,Kenneth H. Mayer,Irving F. Hoffman,Susan H. Eshleman,Estelle Piwowar-Manning,Leslie Cottle,Xinyi C. Zhang,Joseph Makhema,Lisa A. Mills,Ravindre Panchia,Sharlaa Faesen,Joseph J. Eron,Joel E. Gallant,Diane V. Havlir,Susan Swindells,Vanessa Elharrar,David N. Burns,Taha E. Taha,Karin Nielsen-Saines,David D. Celentano,Max Essex,Sarah E. Hudelson,Andrew D. Redd,Thomas R. Fleming +35 more
TL;DR: The early initiation of ART led to a sustained decrease in genetically linked HIV-1 infections in sexual partners, and was associated with a 93% lower risk of linked partner infection than was delayed ART.
Journal ArticleDOI
The 2016 International Society for Heart Lung Transplantation listing criteria for heart transplantation: A 10-year update
Mandeep R. Mehra,Charles E. Canter,Margaret M. Hannan,Marc J. Semigran,Patricia A. Uber,David A. Baran,Lara Danziger-Isakov,James K. Kirklin,Richard Kirk,Sudhir S. Kushwaha,Lars Lund,Luciano Potena,Heather J. Ross,David O. Taylor,Erik A M Verschuuren,Andreas Zuckermann +15 more
TL;DR: The ISHLT Infectious Diseases, Pediatric and Heart Failure and Transplantation Councils Councils, and on behalf of the International Society for Heart Lung Trans transplantation (ISHLT) Infectious diseases, pediatric and heart failure and transplantation councilss are represented.
Journal ArticleDOI
HIV infection: epidemiology, pathogenesis, treatment, and prevention
TL;DR: The role of immune activation in the pathogenesis of non-AIDS clinical events (major causes of morbidity and mortality in people on antiretroviral therapy) is receiving increased recognition and breakthroughs in the prevention of HIV important to public health include male medical circumcision.
Journal ArticleDOI
Impact on life expectancy of HIV-1 positive individuals of CD4+ cell count and viral load response to antiretroviral therapy
Margaret T May,Mark Gompels,Valerie Delpech,Kholoud Porter,Chloe Orkin,Stephen Kegg,Phillip Hay,Margaret Johnson,Adrian Palfreeman,Richard Gilson,David R. Chadwick,Fabiola Martin,Teresa Hill,John Walsh,Frank A. Post,Martin Fisher,Jonathan Ainsworth,Sophie Jose,Clifford Leen,Mark Nelson,Jane Anderson,Caroline A. Sabin +21 more
TL;DR: Patients who started ART with a low CD4+ cell count significantly improve their life expectancy if they have a good CD4- cell count response and undetectable viral load.
Journal ArticleDOI
HIV-infected individuals with low CD4/CD8 ratio despite effective antiretroviral therapy exhibit altered T cell subsets, heightened CD8+ T cell activation, and increased risk of non-AIDS morbidity and mortality.
Sergio Serrano-Villar,Talía Sainz,Sulggi A. Lee,Peter W. Hunt,Elizabeth Sinclair,Barbara L. Shacklett,April L. Ferre,Timothy L. Hayes,Ma Somsouk,Priscilla Y. Hsue,Mark L. Van Natta,Curtis L. Meinert,Michael M. Lederman,Hiroyu Hatano,Vivek Jain,Yong Huang,Frederick Hecht,Jeffrey N. Martin,Joseph M. McCune,Santiago Moreno,Steven G. Deeks +20 more
TL;DR: A persistently low CD4/CD8 ratio during otherwise effective ART is associated with increased innate and adaptive immune activation, an immunosenescent phenotype, and higher risk of morbidity/mortality.
References
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Journal ArticleDOI
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Wafaa El-Sadr,Wafaa El-Sadr,Jens D Lundgren,James D. Neaton,Fred M. Gordin,Dominic Abrams,Roberto C. Arduino,Abdel Babiker,William J. Burman,Nathan Clumeck,Calvin J. Cohen,David V. Cohn,David A. Cooper,Janet Darbyshire,Sean Emery,Gerd Fätkenheuer,Brian Gazzard,Birgit Grund,Jennifer F Hoy,Karin L. Klingman,M. H. Losso,Norman Markowitz,Jacquie Neuhaus,Andrew N. Phillips,Claire Rappoport +24 more
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Psychiatric Disorders and Drug Use Among Human Immunodeficiency Virus–Infected Adults in the United States
Eric G. Bing,M. Audrey Burnam,Douglas Longshore,Douglas Longshore,John A. Fleishman,Cathy D. Sherbourne,Andrew S. London,Barbara J. Turner,Ferd Eggan,Robin L. Beckman,Benedetto Vitiello,Sally C. Morton,Maria Orlando,Samuel A. Bozzette,Samuel A. Bozzette,Lucila Ortiz-Barron,Martin F. Shapiro,Martin F. Shapiro +17 more
TL;DR: Clinicians may need to actively identify those at risk of psychiatric and/or drug dependence disorders and work with policymakers to ensure the availability of appropriate care for these treatable disorders.
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Cardiovascular disease risk factors in HIV patients - association with antiretroviral therapy. Results from the DAD study
Nina Friis-Møller,Rainer Weber,Peter Reiss,Rodolphe Thiébaut,Ole Kirk,Antonella d'Arminio Monforte,Christian Pradier,Linda Morfeldt,Silvia Mateu,Mathew M.G. Law,Wafaa El-Sadr,Stéphane De Wit,Caroline A. Sabin,Andrew N. Phillips,Jens D Lundgren +14 more
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Markers of Inflammation, Coagulation, and Renal Function Are Elevated in Adults with HIV Infection
Jacqueline Neuhaus,David R. Jacobs,Jason V. Baker,Jason V. Baker,Alexandra Calmy,Daniel Duprez,Alberto La Rosa,Lewis H. Kuller,Sarah Pett,Matti Ristola,Michael W. Ross,Michael G. Shlipak,Russell P. Tracy,James D. Neaton +13 more
TL;DR: Levels of high-sensitivity C-reactive protein, IL-6, D-dimer, and cystatin C are elevated in persons with HIV infection and remain so even after HIV RNA levels are suppressed with antiretroviral therapy.
Journal ArticleDOI
Inflamm‐ageing and lifelong antigenic load as major determinants of ageing rate and longevity
TL;DR: Immunosenescence can be taken as proof that the beneficial effects of the immune system become detrimental late in life, in a period not foreseen by evolution, which could explain the mechanisms of the ageing process as well as the pathogenesis of age‐related diseases.
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