Response to Antiretroviral Therapy in HIV Patients of Sub Saharan African Origin in the Swiss HIV Co

1
Response to Antiretroviral Therapy in HIV
Patients of Sub Saharan African Origin in the
Swiss HIV Cohort Study

• C Staehelin, O Keiser, A Calmy, R Weber, M
  Cavassini, L Elzi, P Schmid, E Bernasconi, H
  Furrer
• and the Swiss HIV Cohort Study
• Supported by the Swiss National Science
  Foundation

2
Background / Objective

• Situation on cART
• Response to cART
• Time to undetectable RNA
• Time to viral rebound
• Increase in CD4 count
• Mortality
• Intent to stay on cART

3
Sub-Saharan African (SSA) vs Northwest European
Patients (NWE)
4376 3707

• Treatment naive starting triple ART
• Exclusion if
• - unboosted saquinavir
• planned treatment interruption
• structured treatment interruption, pregnancy
• active iv drug use
• Analysed SSA 598 NWE 3109

4
Baseline Patient Characteristics

5
Follow-up Time and Treatment Regimens

6
Discontinuation in SHCS

7
CD4 increase
8
Time to viral suppression(VL lt50c/ml)
9
Time to viral failure(2x VL gt400c/mL)Intent to
stay on treatment
10
Time to viral failure(2x VL gt400c/mL)only on
cART analysis
11
Survival
F
-
up (yrs)

Deaths

Mortality /100 py

(95 CI)

17136.2

267

1.6 (1.4
-
1.8)

2715.9

15

0.5 (0.3
-
0.9)

Cox Regression
Mortality
SSA, p0.3
SSA, p0.3
CD4
cART
start, p0.001
CD4
cART
start, p0.001
Age 10y
increase
, plt0.001
Age 10y
increase
, plt0.001
Female sex
, p0.3
Female sex
, p0.3
Log10 HIV RNA
cART
start, p0.8
Log10 HIV RNA
cART
start, p0.8
HCV
infection
, plt0.001
HCV
infection
, plt0.001
HBsAg
positive, p0.003
HBsAg
positive, p0.003
AIDS at
cART
start, p0.03
AIDS at
cART
start, p0.03
cART
start
after
1999, p0.4
cART
start
after
1999, p0.4
NNRTI
or boosted
PI, p0.004
NNRTI
or boosted
PI, p0.004
.4
.6
.8
.9
1
1.2
1.6
2
2.4
3.2
4.2
.4
.6
.8
.9
1
1.2
1.6
2
2.4
3.2
4.2
Adjusted
HR
Adjusted
HR
12
Conclusions

• Little evidence for inferior outcome to cART in
  SSA migrants
• HOWEVER
• Higher loss to follow-up
• Concern about longer-term stability of viral
  response

13
Thank you for your attention
twice
twice
The members of the Swiss HIV Cohort Study are M.
Battegay, E. Bernasconi, J. Böni, HC Bucher, Ph.
Bürgisser, A. Calmy, S. Cattacin, M. Cavassini,
R. Dubs, M. Egger, L. Elzi, M. Fischer, M. Flepp,
A. Fontana, P. Francioli (President of the SHCS),
H. Furrer (Chairman of the Clinical and
Laboratory Committee), C. Fux, M. Gorgievski, H.
Günthard (Chairman of the Scientific Board), H.
Hirsch, B. Hirschel, I. Hösli, Ch. Kahlert, L.
Kaiser, U. Karrer, C. Kind, Th. Klimkait, B.
Ledergerber, G. Martinetti, B. Martinez, N.
Müller, D. Nadal, M. Opravil, F. Paccaud, G.
Pantaleo, A. Rauch, S. Regenass, M. Rickenbach
(Head of Data Center), C. Rudin (Chairman of the
Mother Child Substudy), P. Schmid, D. Schultze,
J. Schüpbach, R. Speck, P. Taffé, A. Telenti, A.
Trkola, P. Vernazza, R. Weber, S. Yerly.