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Virologic, immunologic and clinical responses in foreign-born versus US-born HIV-1 infected adults initiating antiretroviral therapy: an observational cohort study.

Parrish DD, Blevins M, Stinnette SE, Rebeiro PF, Shepherd BE, Sterling TR, McGowan CC, Wester CW - PLoS ONE (2012)

Bottom Line: However studies in western countries examining virologic, immunologic and clinical responses after cART initiation in indigenous versus non-indigenous populations have shown mixed results.Foreign-born patients were younger (31.7 years versus 38.5 years), more often female (38.3% versus 27.1%), less often injection drug users (3.2% versus 9.5%) or men who have sex with men (19.0% versus 54.5%), and had higher loss to follow-up rates (14.9% versus 6.2%).Differential rates of loss to follow-up warrant further investigation in the foreign-born population.

View Article: PubMed Central - PubMed

Affiliation: Vanderbilt University Institute for Global Health, Nashville, Tennessee, USA. d.parrish@vanderbilt.edu

ABSTRACT

Introduction: Mortality rates within the first year of combination antiretroviral therapy (cART) initiation are several-fold higher in resource-limited countries than in resource-replete settings. However studies in western countries examining virologic, immunologic and clinical responses after cART initiation in indigenous versus non-indigenous populations have shown mixed results. This study aimed to determine whether there is a difference in these outcomes in a United States setting between foreign-born and US-born patients.

Methods: This retrospective observational cohort study of HIV-1 infected adults in one urban clinic in the United States compared virologic suppression, immune recovery and rates of AIDS defining events (ADEs) within the first year of cART using linear mixed effect models, log rank tests and Cox proportional hazard models. Data were analyzed for 94 foreign-born and 1242 US-born patients.

Results: Foreign-born patients were younger (31.7 years versus 38.5 years), more often female (38.3% versus 27.1%), less often injection drug users (3.2% versus 9.5%) or men who have sex with men (19.0% versus 54.5%), and had higher loss to follow-up rates (14.9% versus 6.2%). No significant differences were detected between the groups in suppression of plasma HIV-1 RNA, CD4+ cell recovery or development of ADEs.

Conclusions: During the first year on cART, virologic suppression, immune recovery and development of ADEs were comparable between foreign-born and US-born patients in care in a US clinic. Differential rates of loss to follow-up warrant further investigation in the foreign-born population.

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Related in: MedlinePlus

Viral load by time on combined antiretroviral therapy.Adjusted for sex, age and baseline CD4+ cell count.
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pone-0052336-g001: Viral load by time on combined antiretroviral therapy.Adjusted for sex, age and baseline CD4+ cell count.

Mentions: Plasma viral load suppression and CD4+ cell recovery remained comparable in the two groups throughout the year (Figures 1 and 2), with overlapping confidence intervals in both the plasma HIV-1 RNA level and CD4+ cell count curves. At 90 days, 70.4% of foreign-born and 64.8% of US born patients had suppressed viral loads (plasma HIV-1 RNA <400 copies/ml). Estimated expected plasma HIV-1 RNA levels were 137 copies/ml (95% CI: 86–220) and 188 copies/ml (95% CI: 162–218) in foreign-born and US-born patients respectively while expected CD4+ cell counts were 312 cells/ul (95% CI: 288–336) and 314 cells/ul (95% CI: 307–322). At 360 days, 57.2% of foreign-born and 53.8% of US born patients had suppressed viral loads. Estimated expected HIV-1 RNA levels in foreign-born and US-born patients were 278 copies/ml (95% CI: 128–602) and 330 copies/ml (95% CI: 261–418), respectively, with CD4+ cell counts of 381 cells/ul (95% CI: 331–434) and 360 cells/ul (95% CI: 345–376). Rates of AIDS-defining events (ADE)s were similar in the two groups, with 11 foreign-born patients (11.7%) versus 152 US-born patients (12.2%) developing ADEs within the first year following cART initiation (aHR 1.04; 95% CI: 0.57–1.93). One year crude mortality rates were 1.2% and 4.7% in foreign-born and US-born patients respectively (aHR 0.26; 95%CI 0.04–1.87).


Virologic, immunologic and clinical responses in foreign-born versus US-born HIV-1 infected adults initiating antiretroviral therapy: an observational cohort study.

Parrish DD, Blevins M, Stinnette SE, Rebeiro PF, Shepherd BE, Sterling TR, McGowan CC, Wester CW - PLoS ONE (2012)

Viral load by time on combined antiretroviral therapy.Adjusted for sex, age and baseline CD4+ cell count.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3526482&req=5

pone-0052336-g001: Viral load by time on combined antiretroviral therapy.Adjusted for sex, age and baseline CD4+ cell count.
Mentions: Plasma viral load suppression and CD4+ cell recovery remained comparable in the two groups throughout the year (Figures 1 and 2), with overlapping confidence intervals in both the plasma HIV-1 RNA level and CD4+ cell count curves. At 90 days, 70.4% of foreign-born and 64.8% of US born patients had suppressed viral loads (plasma HIV-1 RNA <400 copies/ml). Estimated expected plasma HIV-1 RNA levels were 137 copies/ml (95% CI: 86–220) and 188 copies/ml (95% CI: 162–218) in foreign-born and US-born patients respectively while expected CD4+ cell counts were 312 cells/ul (95% CI: 288–336) and 314 cells/ul (95% CI: 307–322). At 360 days, 57.2% of foreign-born and 53.8% of US born patients had suppressed viral loads. Estimated expected HIV-1 RNA levels in foreign-born and US-born patients were 278 copies/ml (95% CI: 128–602) and 330 copies/ml (95% CI: 261–418), respectively, with CD4+ cell counts of 381 cells/ul (95% CI: 331–434) and 360 cells/ul (95% CI: 345–376). Rates of AIDS-defining events (ADE)s were similar in the two groups, with 11 foreign-born patients (11.7%) versus 152 US-born patients (12.2%) developing ADEs within the first year following cART initiation (aHR 1.04; 95% CI: 0.57–1.93). One year crude mortality rates were 1.2% and 4.7% in foreign-born and US-born patients respectively (aHR 0.26; 95%CI 0.04–1.87).

Bottom Line: However studies in western countries examining virologic, immunologic and clinical responses after cART initiation in indigenous versus non-indigenous populations have shown mixed results.Foreign-born patients were younger (31.7 years versus 38.5 years), more often female (38.3% versus 27.1%), less often injection drug users (3.2% versus 9.5%) or men who have sex with men (19.0% versus 54.5%), and had higher loss to follow-up rates (14.9% versus 6.2%).Differential rates of loss to follow-up warrant further investigation in the foreign-born population.

View Article: PubMed Central - PubMed

Affiliation: Vanderbilt University Institute for Global Health, Nashville, Tennessee, USA. d.parrish@vanderbilt.edu

ABSTRACT

Introduction: Mortality rates within the first year of combination antiretroviral therapy (cART) initiation are several-fold higher in resource-limited countries than in resource-replete settings. However studies in western countries examining virologic, immunologic and clinical responses after cART initiation in indigenous versus non-indigenous populations have shown mixed results. This study aimed to determine whether there is a difference in these outcomes in a United States setting between foreign-born and US-born patients.

Methods: This retrospective observational cohort study of HIV-1 infected adults in one urban clinic in the United States compared virologic suppression, immune recovery and rates of AIDS defining events (ADEs) within the first year of cART using linear mixed effect models, log rank tests and Cox proportional hazard models. Data were analyzed for 94 foreign-born and 1242 US-born patients.

Results: Foreign-born patients were younger (31.7 years versus 38.5 years), more often female (38.3% versus 27.1%), less often injection drug users (3.2% versus 9.5%) or men who have sex with men (19.0% versus 54.5%), and had higher loss to follow-up rates (14.9% versus 6.2%). No significant differences were detected between the groups in suppression of plasma HIV-1 RNA, CD4+ cell recovery or development of ADEs.

Conclusions: During the first year on cART, virologic suppression, immune recovery and development of ADEs were comparable between foreign-born and US-born patients in care in a US clinic. Differential rates of loss to follow-up warrant further investigation in the foreign-born population.

Show MeSH
Related in: MedlinePlus