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Serious Fatal and Non-fatal Non-AIDS-defining Illnesses in Europe: most common no-AIDS events malignancies/CVD/liver in EuroSida
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Reported by Jules Levin_CROI 209 Feb 8-12 Montreal__
the most common non-ADI were malignancies, CVD and liver failure, of ADIs were oesophageal candidiasis, PCP and
pulmonary tuberculosis. Increased duration of immunosupression with a CD4 count <200/mm3 was also associated with an increased incidence of non-ADIs. Non-ADIs were more common than ADIs in the cART era, they have considerably mortality and should be routinely reported in clinical trials and observational studies. The risk factor profile for non-ADIs was diverse with multiple potentially modifiable immunodeficiency and lifestyle-related risk factors. Evidence on the impact of modifying these factors on the risk of non-ADI is an important but unmet research need.
Reported by Jules Levin_CROI 2009 Feb 8-12 Montreal__Amanda Mocroft*1, P Reiss2, J Gasiorowski3, B Ledergerber4, A Chiesi5, J Gatell6, A Rakhmanova7, M Johnson8, O Kirk9, J Lundgren9,10, and the EuroSIDA Study Group
1Royal Free and Univ Coll Med Sch, London, UK; 2Academisch Medisch Centrum bij de Universiteit van Amsterdam, Amsterdam, The Netherlands; 3Med Univ, Wroclaw, Poland; 4Univ Hosp, Zurich, Switzerland; 5Inst Superiore di Sanita, Rome, Italy; 6Hosp Clin i Provincial, Barcelona, Spain; 7Medical Academy Botkin Hospital, St Petersburg, Russia; 8Royal Free Hosp, London, UK; 9Copenhagen HIV Program, Panum Institute, Copenhagen, Denmark; and 10Centre for Viral Disease KMA, Rigshospitalet, Copenhagen, Denmark
Background: There is a perception that diseases thought to be non-HIV related are becoming increasingly common, but little is known about the incidence and risk factors for serious non-AIDS-defining illnesses.
Methods: The incidence after January 1, 2002 was calculated of non-AIDS-defining illnesses (malignancies, end-stage renal disease, liver failure [grade III/IV hepatic encephalopathy, death from liver-related disease], pancreatitis, cardiovascular disease [acute myocardial infarction or stroke; CVD]) and AIDS-defining illnesses. Poisson regression was used to investigate factors associated with non-AIDS-defining illnesses and AIDS-defining illnesses.
Results: Among 10341 patients, 684 were diagnosed with a non-AIDS-defining illnesses (incidence 16.5 per 1000 person-years of follow-up; 95%CI 15.3 to 17.7); 316 patients (46.5%) died. In comparison, the incidence of AIDS-defining illnesses (641 diagnoses; 219 deaths, 34.5%) was 15.5 of 1000 person-years of follow-up (14.3 to 16.7). The most common non-AIDS-defining illnesses were malignancy (255, 36.5%), CVD (209, 29.9%), and liver failure (136, 19.5%). The incidence of non-AIDS-defining illnesses was markedly lower at higher current CD4 counts and was similar to, or exceeded the incidence of AIDS-defining illnesses at all current CD4 counts ≥100/mm3 (see the figure). The table shows the adjusted incidence rate ratios for developing a non-AIDS-defining illnesses or an AIDS-defining illnesses. Having diabetes or hypertension or being a current smoker all significantly increased the incidence of non-AIDS-defining illnesses. A patient with a current (i.e. latest) CD4 count twice the level of a comparable patient had a 23% lower incidence of a non-AIDS-defining illnesses.
Conclusions: Non-AIDS-defining illnesses were more common than AIDS-defining illnesses in the combination ART era, have considerable mortality, and should be routinely reported in clinical trials and observational studies. The risk factor profile for non-AIDS-defining illnesses was diverse with multiple potentially modifiable immunodeficiency and lifestyle-related risk factors. Evidence on the influence of modifying these factors on the risk of non-AIDS-defining illness is an important but unmet research need.
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