Abstract
Background—The extent to which mortality differs following individual acquired
immunodeficiency syndrome (AIDS)–defining events (ADEs) has not been assessed among
patients initiating combination antiretroviral therapy.
Methods—We analyzed data from 31,620 patients with no prior ADEs who started combination
antiretroviral therapy. Cox proportional hazards models were used to estimate mortality hazard
ratios for each ADE that occurred in >50 patients, after stratification by cohort and adjustment for
sex, HIV transmission group, number of anti-retroviral drugs initiated, regimen, age, date of
starting combination antiretroviral therapy, and CD4+ cell count and HIV RNA load at initiation
of combination antiretroviral therapy. ADEs that occurred in <50 patients were grouped together
to form a “rare ADEs” category.
Results—During a median follow-up period of 43 months (interquartile range, 19–70 months),
2880 ADEs were diagnosed in 2262 patients; 1146 patients died. The most common ADEs were
esophageal candidiasis (in 360 patients), Pneumocystis jiroveci pneumonia (320 patients), and
Kaposi sarcoma (308 patients). The greatest mortality hazard ratio was associated with non-
Hodgkin’s lymphoma (hazard ratio, 17.59; 95% confidence interval, 13.84–22.35) and progressive
multifocal leukoencephalopathy (hazard ratio, 10.0; 95% confidence interval, 6.70–14.92). Three
groups of ADEs were identified on the basis of the ranked hazard ratios with bootstrapped
confidence intervals: severe (non-Hodgkin’s lymphoma and progressive multifocal
leukoencephalopathy [hazard ratio, 7.26; 95% confidence interval, 5.55–9.48]), moderate
(cryptococcosis, cerebral toxoplasmosis, AIDS dementia complex, disseminated Mycobacterium
avium complex, and rare ADEs [hazard ratio, 2.35; 95% confidence interval, 1.76–3.13]), and
mild (all other ADEs [hazard ratio, 1.47; 95% confidence interval, 1.08–2.00]).
Conclusions—In the combination antiretroviral therapy era, mortality rates subsequent to an
ADE depend on the specific diagnosis. The proposed classification of ADEs may be useful in
clinical end point trials, prognostic studies, and patient management.
Variable impact on mortality of AIDS-defining events diagnosed during combination antiretroviral therapy: not all AIDS-defining conditions are created equal / Antiretroviral Therapy Cohort Collaboration Mocroft, A; Sterne, Ja; Egger, M; May, M; Grabar, S; Furrer, H; Sabin, C; Fatkenheuer, G; Justice, A; Reiss, P; d'Arminio Monforte, A; Gill, J; Hogg, R; Bonnet, F; Kitahata, M; Staszewski, S; Casabona, J; Harris, R; Saag, M; Casabona, J; Chêne, G; Costagliola, D; Dabis, F; D'Arminio Monforte, A; de Wolf, F; Egger, M; Fatkenheuer, G; Gill, J; Hogg, R; Justice, A; Kitahata, M; Ledergerber, B; Mocroft, A; Phillips, A; Reiss, P; Saag, M; Sabin, C; Staszewski, S; Weller, I; May, M; Harris, R; Sterne, J; Abgrall, S; Barin, F; Bentata, M; Billaud, E; Boué, F; Burty, C; Cabié, A; Cotte, L; De Truchis, P; Duval, X; Duvivier, C; Enel, P; Fredouille Heripret, L; Gasnault, J; Gaud, C; Gilquin, J; Grabar, S; Katlama, C; Khuong, Ma; Lang, Jm; Lascaux, As; Launay, O; Mahamat, A; Mary Krause, M; Matheron, S; Meynard, Jl; Pavie, J; Pialoux, G; Pilorgé, F; Poizot Martin, I; Pradier, C; Reynes, J; Rouveix, E; Simon, A; Tattevin, P; Tissot Dupont, H; Viard, Jp; Viget, N; Pariente Khayat, A; Salomon, V; Jacquemet, N; Rivet, A; Guiguet, M; Kousignian, I; Lanoy, E; Lièvre, L; Potard, V; Selinger Leneman, H; Bouvet, E; Crickx, B; Ecobichon, Jl; Leport, C; Picard Dahan, C; Yeni, P; Tisne Dessus, D; Weiss, L; Salmon, D; Sicard, D; Auperin, I; Roudière, L; Fior, R; Delfraissy, Jf; Goujard, C; Jung, C; Lesprit, P; Desplanque, N; Meyohas, Mc; Picard, O; Cadranel, J; Mayaud, C; Bricaire, F; Herson, S; Clauvel, Jp; Decazes, Jm; Gerard, L; Molina, Jm; Diemer, M; Sellier, P; Berthé, H; Dupont, C; Chandemerle, C; Mortier, E; Honoré, P; Jeantils, V; Tassi, S; Mechali, D; Taverne, B; Gourdon, F; Laurichesse, H; Fresard, A; Lucht, F; Eglinger, P; Faller, Jp; Bazin, C; Verdon, R; Boibieux, A; Peyramond, D; Livrozet, Jm; Touraine, Jl; Trepo, C; Ravaux, I; Delmont, Jp; Moreau, J; Gastaut, Ja; Retornaz, F; Soubeyrand, J; Allegre, T; Blanc, Pa; Galinier, A; Ruiz, Jm; Lepeu, G; Granet Brunello, P; Esterni, Jp; Pelissier, L; Cohen Valensi, R; Nezri, M; Chadapaud, S; Laffeuillade, A; May, T; Rabaud, C; Raffi, F; Arvieux, C; Michelet, C; Borsa Lebas, F; Caron, F; Fraisse, P; Rey, D; Arlet Suau, E; Cuzin, L; Massip, P; Thiercelin Legrand, Mf; Yasdanpanah, Y; Pradinaud, R; Sobesky, M; Contant, M; Montroni, M; Scalise, G; Braschi, Mc; Riva, A; Tirelli, U; Martellotta, F; Pastore, G; Ladisa, N; Suter, F; Arici, C; Chiodo, F; Colangeli, V; Fiorini, C; Carosi, G; Cristini, G; Torti, C; Minardi, C; Bertelli, D; Quirino, T; Manconi, Pe; Piano, P; Cosco, L; Scerbo, A; Vecchiet, J; D'Alessandro, M; Santoro, D; Pusterla, L; Carnevale, G; Lorenzotti, S; Viganò, P; Mena, M; Ghinelli, F; Sighinolfi, L; Leoncini, F; Mazzotta, F; Pozzi, M; Lo Caputo, S; Grisorio, B; Ferrara, S; Grima, P; Grima, Pf; Pagano, G; Cassola, G; Alessandrini, A; Piscopo, R; Toti, M; Trezzi, M; Soscia, F; Tacconi, L; Orani, A; Perini, P; Scasso, A; 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Colette Kempf, M; Allison, Jj; Pisu, M.. - In: CLINICAL INFECTIOUS DISEASES. - ISSN 1058-4838. - STAMPA. - 48:8(2009), pp. 1138-1151.
Variable impact on mortality of AIDS-defining events diagnosed during combination antiretroviral therapy: not all AIDS-defining conditions are created equal.
Antiretroviral Therapy Cohort Collaboration Mocroft A; Sterne JA; Egger M; May M; Grabar S; Furrer H; Sabin C; Fatkenheuer G; Justice A; Reiss P; d'Arminio Monforte A; Gill J; Hogg R; Bonnet F; Kitahata M; Staszewski S; Casabona J; Harris R; Saag M; Casabona J; Chêne G; Costagliola D; Dabis F; D'Arminio Monforte A; de Wolf F; Egger M; Fatkenheuer G; Gill J; Hogg R; Justice A; Kitahata M; Ledergerber B; Mocroft A; Phillips A; Reiss P; Saag M; Sabin C; Staszewski S; Weller I; May M; Harris R; Sterne J; Abgrall S; Barin F; Bentata M; Billaud E; Boué F; Burty C; Cabié A; Cotte L; De Truchis P; Duval X; Duvivier C; Enel P; Fredouille Heripret L; Gasnault J; Gaud C; Gilquin J; Grabar S; Katlama C; Khuong MA; Lang JM; Lascaux AS; Launay O; Mahamat A; Mary Krause M; Matheron S; Meynard JL; Pavie J; Pialoux G; Pilorgé F; Poizot Martin I; Pradier C; Reynes J; Rouveix E; Simon A; Tattevin P; Tissot Dupont H; Viard JP; Viget N; Pariente Khayat A; Salomon V; Jacquemet N; Rivet A; Guiguet M; Kousignian I; Lanoy E; Lièvre L; Potard V; Selinger Leneman H; Bouvet E; Crickx B; Ecobichon JL; Leport C; Picard Dahan C; Yeni P; Tisne Dessus D; Weiss L; Salmon D; Sicard D; Auperin I; Roudière L; Fior R; Delfraissy JF; Goujard C; Jung C; Lesprit P; Desplanque N; Meyohas MC; Picard O; Cadranel J; Mayaud C; Bricaire F; Herson S; Clauvel JP; Decazes JM; Gerard L; Molina JM; Diemer M; Sellier P; Berthé H; Dupont C; Chandemerle C; Mortier E; Honoré P; Jeantils V; Tassi S; Mechali D; Taverne B; Gourdon F; Laurichesse H; Fresard A; Lucht F; Eglinger P; Faller JP; Bazin C; Verdon R; Boibieux A; Peyramond D; Livrozet JM; Touraine JL; Trepo C; Ravaux I; Delmont JP; Moreau J; Gastaut JA; Retornaz F; Soubeyrand J; Allegre T; Blanc PA; Galinier A; Ruiz JM; Lepeu G; Granet Brunello P; Esterni JP; Pelissier L; Cohen Valensi R; Nezri M; Chadapaud S; Laffeuillade A; May T; Rabaud C; Raffi F; Arvieux C; Michelet C; Borsa Lebas F; Caron F; Fraisse P; Rey D; Arlet Suau E; Cuzin L; Massip P; Thiercelin Legrand MF; Yasdanpanah Y; Pradinaud R; Sobesky M; Contant M; Montroni M; Scalise G; Braschi MC; Riva A; Tirelli U; Martellotta F; Pastore G; Ladisa N; Suter F; Arici C; Chiodo F; Colangeli V; Fiorini C; Carosi G; Cristini G; Torti C; Minardi C; Bertelli D; Quirino T; Manconi PE; Piano P; Cosco L; Scerbo A; Vecchiet J; D'Alessandro M; Santoro D; Pusterla L; Carnevale G; Lorenzotti S; Viganò P; Mena M; Ghinelli F; Sighinolfi L; Leoncini F; Mazzotta F; Pozzi M; Lo Caputo S; Grisorio B; Ferrara S; Grima P; Grima PF; Pagano G; Cassola G; Alessandrini A; Piscopo R; Toti M; Trezzi M; Soscia F; Tacconi L; Orani A; Perini P; Scasso A; Vincenti A; Chiodera F; Castelli P; Scalzini A; Palvarini L; Moroni M; Lazzarin A; Rizzardini G; Caggese L; Cicconi P; Galli A; Merli S; Pastecchia C; Moioli MC; Esposito R; Mussini C; Abrescia N; Chirianni A; Izzo CM; Piazza M; De Marco M; Viglietti R; Manzillo E; NAPPA, SALVATORE ;Colomba A; Abbadessa V; Prestileo T; Mancuso S; Ferrari C; Pizzaferri P; Filice G; Minoli L; Bruno R; Novati S; Baldelli F; Camanni G; Petrelli E; Cioppi A; Alberici F; Ruggieri A; Menichetti F; Martinelli C; De Stefano C; La Gala A; Ballardini G; Rizzo E; Magnani G; Ursitti MA; Arlotti M; Ortolani P; Cauda R; Dianzani F; Ippolito G; Antinori A; Antonucci G; Ciardi M; Narciso P; Petrosillo N; Vullo V; De Luca A; Zaccarelli M; Acinapura R; De Longis P; Trotta MP; Noto P; Lichtner M; Capobianchi MR; Carletti F; Girardi E; Pezzotti P; Rezza G; Mura MS; Mannazzu M; Caramello P; Di Perri G; Orofino GC; Sciandra M; Grossi PA; Basilico C; Poggio A; Bottari G; Raise E; Ebo F; Pellizzer G; Buonfrate D; Resta F; Loso K; Cozzi Lepri A; Battegay M; Bernasconi E; Böni J; Bucher H; Bürgisser P; Cattacin S; Cavassini M; Dubs R; Elzi L; Erb P; Fischer M; Flepp M; Fontana A; Francioli P; Furrer H; Gorgievski M; Günthard H; Hirsch H; Hirschel B; Hösli I; Kahlert C; Kaiser L; Karrer U; Kind C; Klimkait T; Martinetti G; Martinez B; Müller N; Nadal D; Opravil M; Paccaud F; Pantaleo G; Rickenbach M; Rudin C; Schmid P; Schultze D; Schüpbach J; Speck R; Taffé P; Tarr P; Telenti A; Trkola A; Vernazza P; Weber R; Yerly S; Gras LA; van Sighem AI; Smit C; Bronsveld W; Hillebrand Haverkort ME; Prins JM; Branger J; Eeftinck Schattenkerk JK; Gisolf J; Godfried MH; Lange JM; Lettinga KD; van der Meer JT; Nellen FJ; van der Poll T; Ruys TA; Steingrover R; Vermeulen JN; Vrouenraets SM; van Vugt M; Wit FW; Kuijpers TW; Pajkrt D; Scherpbier HJ; van Eeden A; Brinkman K; van den Berk GE; Blok WL; Frissen PH; Roos JC; Schouten WE; Mulder JW; van Gorp EC; Wagenaar J; Veenstra J; Danner SA; Van Agtmael MA; Claessen FA; Perenboom RM; Rijkeboer A; van Vonderen MG; Richter C; van der Berg J; Vriesendorp R; Jeurissen FJ; Kauffmann RH; Pogány K; Bravenboer B; ten Napel CH; Kootstra GJ; Sprenger HG; van Assen S; van Leeuwen JT; Doedens R; Scholvinck EH; ten Kate RW; Soetekouw R; van Houte D; Polée MB; Kroon FP; van den Broek PJ; van Dissel JT; Schippers EF; Schreij G; van der Geest S; Lowe S; Verbon A; Koopmans PP; Van Crevel R; 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Allison JJ; Pisu M.
2009
Abstract
Abstract
Background—The extent to which mortality differs following individual acquired
immunodeficiency syndrome (AIDS)–defining events (ADEs) has not been assessed among
patients initiating combination antiretroviral therapy.
Methods—We analyzed data from 31,620 patients with no prior ADEs who started combination
antiretroviral therapy. Cox proportional hazards models were used to estimate mortality hazard
ratios for each ADE that occurred in >50 patients, after stratification by cohort and adjustment for
sex, HIV transmission group, number of anti-retroviral drugs initiated, regimen, age, date of
starting combination antiretroviral therapy, and CD4+ cell count and HIV RNA load at initiation
of combination antiretroviral therapy. ADEs that occurred in <50 patients were grouped together
to form a “rare ADEs” category.
Results—During a median follow-up period of 43 months (interquartile range, 19–70 months),
2880 ADEs were diagnosed in 2262 patients; 1146 patients died. The most common ADEs were
esophageal candidiasis (in 360 patients), Pneumocystis jiroveci pneumonia (320 patients), and
Kaposi sarcoma (308 patients). The greatest mortality hazard ratio was associated with non-
Hodgkin’s lymphoma (hazard ratio, 17.59; 95% confidence interval, 13.84–22.35) and progressive
multifocal leukoencephalopathy (hazard ratio, 10.0; 95% confidence interval, 6.70–14.92). Three
groups of ADEs were identified on the basis of the ranked hazard ratios with bootstrapped
confidence intervals: severe (non-Hodgkin’s lymphoma and progressive multifocal
leukoencephalopathy [hazard ratio, 7.26; 95% confidence interval, 5.55–9.48]), moderate
(cryptococcosis, cerebral toxoplasmosis, AIDS dementia complex, disseminated Mycobacterium
avium complex, and rare ADEs [hazard ratio, 2.35; 95% confidence interval, 1.76–3.13]), and
mild (all other ADEs [hazard ratio, 1.47; 95% confidence interval, 1.08–2.00]).
Conclusions—In the combination antiretroviral therapy era, mortality rates subsequent to an
ADE depend on the specific diagnosis. The proposed classification of ADEs may be useful in
clinical end point trials, prognostic studies, and patient management.
Citazione
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Il report seguente simula gli indicatori relativi alla propria produzione scientifica in relazione alle soglie ASN 2023-2025 del proprio SC/SSD. Si ricorda che il superamento dei valori soglia (almeno 2 su 3) è requisito necessario ma non sufficiente al conseguimento dell'abilitazione. La simulazione si basa sui dati IRIS e sugli indicatori bibliometrici alla data indicata e non tiene conto di eventuali periodi di congedo obbligatorio, che in sede di domanda ASN danno diritto a incrementi percentuali dei valori. La simulazione può differire dall'esito di un’eventuale domanda ASN sia per errori di catalogazione e/o dati mancanti in IRIS, sia per la variabilità dei dati bibliometrici nel tempo. Si consideri che Anvur calcola i valori degli indicatori all'ultima data utile per la presentazione delle domande. La presente simulazione è stata realizzata sulla base delle specifiche raccolte sul tavolo ER del Focus Group IRIS coordinato dall’Università di Modena e Reggio Emilia e delle regole riportate nel DM 589/2018 e allegata Tabella A. Cineca, l’Università di Modena e Reggio Emilia e il Focus Group IRIS non si assumono alcuna responsabilità in merito all’uso che il diretto interessato o terzi faranno della simulazione. Si specifica inoltre che la simulazione contiene calcoli effettuati con dati e algoritmi di pubblico dominio e deve quindi essere considerata come un mero ausilio al calcolo svolgibile manualmente o con strumenti equivalenti.