HIV Screening in the Dental Setting

 

More Than One Third of Italian Group Alive With HIV for Quarter Century

 
 

More Than One Third of Italian Group Alive With HIV for Quarter Century
HIV Drug Therapy, Glasgow 2018, October 28-31, 2018, Glasgow


Mark Mascolini

More than one third of HIV-positive people seen in an Italian clinic survived at least 25 years, and all but 2 were alive at the time of this report [1]. Four survival predictors emerged: younger initial age, lack of an AIDS illness during follow-up, HCV antibody positivity, and treatment with combination antiretroviral therapy (cART).

A growing fraction of people with HIV has carried the virus for 25 years or more, a feat requiring survival since the years before cART. But little research has explored factors favoring long survival among people with HIV. Researchers at the University of Catania in Sicily aimed to address that need by studying long-term survivors among people diagnosed with HIV between 1985 and 1992--a span entirely in the pre-cART era. They defined long-term survival as living more than 25 years (300 months) with HIV infection.

The study group included 186 people, 148 of them (79.5%) men and all but 1 Caucasian. One hundred study participants (53.8%) were people who inject drugs, 20.4% were men who have sex with men, and 17.7% heterosexuals. Median initial age stood at 28 years (interquartile range [IQR] 24.6 to 34.5) and median CD4 count at 239 (IQR 56 to 477). Fifty-eight people (31.2%) had AIDS when diagnosed with HIV, and 53% had HCV coinfection.

After eliminating 5% of the group who dropped out of care, the researchers had 176 cohort members, 72 of whom (38.7% of the original 186) survived at least 25 years after HIV diagnosis. Seventy of these 72 were alive at the time of this report. Long-term survivors had lived for a median of 350 months (IQR 318 to 378) with HIV infection, while the others survived for a median of 37 months (IQR 14 to 121).

During follow-up 102 of 176 people had an AIDS illness diagnosis and AIDS explained 81% of all deaths. Only 1 long-term survivor had AIDS at HIV diagnosis, compared with 55% of nonsurvivors. During follow-up 16 long-term survivors versus 86 nonsurvivors had AIDS (22% versus 83%, P < 0.00001). Age at HIV diagnosis was significantly younger in long-term survivors (26 versus 29 years, P < 0.00001).

Median initial CD4 count at HIV diagnosis lay significantly higher among long-term survivors (median 397 versus 78, P < 0.0001), as did CD4/CD8 ratio (0.4 versus 0.24, P = 0.024). During follow-up 75% of long-term survivors received suboptimal ART and 100% eventually got cART. Proportions of nonsurvivors who received suboptimal ART and CART were 45% and 24% (P < 0.0001 versus long-term survivor rates).

Multivariate logistic regression identified four independent predictors of long-term survival: younger age at HIV diagnosis, lack of an AIDS illness during follow-up, treatment with cART, and HCV antibody positivity, which boosted odds of long-term survival 6-fold (adjusted odds ratio 6.063, 95% confidence interval 1.218 to 30.18, P = 0.0277). The researchers do not speculate on how exposure to HCV might favor longer survival. It could be that the high proportion of drug injectors in their cohort (53.8%), who would account for many HCV-positives, received more focused or consistent care over the years.

The Catania clinicians proposed that cART must be considered the "main actor" in promoting long-term survival in this study group. Only one quarter of nonsurvivors received cART, apparently because many died before cART arrived.

Reference
1. Anile L, Marino A, Gussio M, et al. Long-term survivors in a cohort of HIV+ patients diagnosed between 1985 and 1992: predictive factors associated with more than 25 years of survival. HIV Drug Therapy, Glasgow 2018, October 28-31, 2018, Glasgow. Abstract P046.