Mortality of treated HIV-1 positive individuals according to viral subtype in Europe and Canada: collaborative cohort analysis.

TitleMortality of treated HIV-1 positive individuals according to viral subtype in Europe and Canada: collaborative cohort analysis.
Publication TypeJournal Article
Year of Publication2016
Corporate AuthorsAntiretroviral Therapy Cohort Collaboration(ART-CC), Canadian Observational Cohort Collaboration(CANOC), UK Collaborative HIV Cohort Study(UK CHIC) and Collaboration of Observational HIV Epidemiological Research in Europe(COHERE)
JournalAIDS
Volume30
Issue3
Pagination503-13
Date Published2016 Jan 28
ISSN1473-5571
KeywordsAdult, Anti-Retroviral Agents, Canada, Cohort Studies, Cooperative Behavior, Europe, Female, Genotype, HIV Infections, HIV-1, Humans, Male, Middle Aged, Prognosis, Survival Analysis
Abstract

OBJECTIVES: To estimate prognosis by viral subtype in HIV-1-infected individuals from start of antiretroviral therapy (ART) and after viral failure.DESIGN: Collaborative analysis of data from eight European and three Canadian cohorts.METHODS: Adults (N>20 000) who started triple ART between 1996 and 2012 and had data on viral subtype were followed for mortality. We estimated crude and adjusted (for age, sex, regimen, CD4 cell count, and AIDS at baseline, period of starting ART, stratified by cohort, region of origin and risk group) mortality hazard ratios (MHR) by subtype. We estimated MHR subsequent to viral failure defined as two HIV-RNA measurements greater than 500 copies/ml after achieving viral suppression.RESULTS: The most prevalent subtypes were B (15 419; 74%), C (2091; 10%), CRF02AG (1057; 5%), A (873; 4%), CRF01AE (506; 2.4%), G (359; 1.7%), and D (232; 1.1%). Subtypes were strongly patterned by region of origin and risk group. During 104 649 person-years of observation, 1172/20 784 patients died. Compared with subtype B, mortality was higher for subtype A, but similar for all other subtypes. MHR for A versus B were 1.13 (95% confidence interval 0.85,1.50) when stratified by cohort, increased to 1.78 (1.27,2.51) on stratification by region and risk, and attenuated to 1.59 (1.14,2.23) on adjustment for covariates. MHR for A versus B was 2.65 (1.64,4.28) and 0.95 (0.57,1.57) for patients who started ART with CD4 cell count below, or more than, 100 cells/μl, respectively. There was no difference in mortality between subtypes A, B and C after viral failure.CONCLUSION: Patients with subtype A had worse prognosis, an observation which may be confounded by socio-demographic factors.

DOI10.1097/QAD.0000000000000941
Alternate JournalAIDS
PubMed ID26562844
PubMed Central IDPMC4711384
Grant ListMR/M004236/1 / / Medical Research Council / United Kingdom
G0600337 / / Medical Research Council / United Kingdom
G0000199 / / Medical Research Council / United Kingdom
G0900274 / / Medical Research Council / United Kingdom
G0700820 / / Medical Research Council / United Kingdom
MC_UU_12023/15 / / Medical Research Council / United Kingdom
MR/J002380/1 / / Medical Research Council / United Kingdom
/ / Canadian Institutes of Health Research / Canada