13th January Mocroft et al., Outcomes in antiretroviral-naïve adults

Treatment outcomes of integrase inhibitors, boosted protease inhibitors and non-nucleoside reverse transcriptase inhibitors in antiretroviral naïve persons starting treatment.   HIV Medicine

Mocroft et al. on behalf of the RESPOND study-group aimed to compare shorter term virological and immunological outcomes and clinical events of AIDS/death in ART-naïve persons starting antiretroviral therapy (ART) in RESPOND with either an integrase strand transfer inhibitor (INSTI), contemporary boosted protease inhibitors (PI/b) or nonnucleoside reverse transcriptase inhibitors (NNRTIs) in key subgroups.

The International Cohort Consortium of Infectious Diseases (RESPOND) is a collaboration of 17 cohort studies, including 29’432 HIV-1-positive persons from across Europe and Australia. The composite treatment outcome (cTO) defined success as viral load (VL) <200 HIV-1 RNA copies/mL with no regimen change and no AIDS/death events. Immunological success was defined as a CD4 count >750 cells/lL or a 33% increase where the baseline CD4 count was ≥500 cells/lL.

Of 5’198 ART-naıve persons in RESPOND, 45.4% started INSTIs, 26.0% PI/b and 28.7% NNRTIs; 880 (17.4%) were aged >50 years, 2539 (49.4%) had CD4 counts <350 cells/lL and 1891 (36.8%) had VL >100 000 copies/mL. Differences in virological and immunological success and clinical failure among ART classes were similar across age groups (≤40, 40 –50 and >50 years), CD4 count categories (≤350 vs. >350 cells/lL) and VL categories at ART initiation (≤100 000 vs. >100 000 copies/mL), with all investigated interactions being nonsignificant (P >0.05).

In conclusion, differences among ART classes in virological, immunological and clinical outcomes in ART-naïve participants were consistent irrespective of age, immune suppression or VL at ART initiation. While confounding by indication cannot be excluded, this provides reassuring evidence that such subpopulations will equally benefit from modern ART.


6th January Kusejko et al., The interplay of HIV and latent tuberculosis

Diagnosis of latent tuberculosis infection is associated with reduced HIV viral load and lower risk for opportunistic infections in people living with HIV.     PLoS Biology

Kusejko et al. aimed to investigate the association of Mycobacterium tuberculosis (MTB) status with HIV disease progression, including both the HIV set point viral load (SPVL) and the occurrence of opportunistic infections (OIs).

The authors sorted all participants of the Swiss HIV Cohort Study (SHCS) with at least 1 documented MTB test into one of the 3 groups: MTB uninfected, latent TB infection (LTBI), or active TB. In adjusted models, they corrected for baseline demographic characteristics, i.e., HIV transmission risk group and gender, geographic region, year of HIV diagnosis, and CD4 nadir.

A total of 13’943 SHCS patients had at least 1 MTB test documented, of whom 840 (6.0%) had LTBI and 770 (5.5%) developed active TB. Compared to MTB uninfected patients, LTBI was associated with a 0.24 decreased log HIV SPVL in the adjusted model (p < 0.0001). Patients with LTBI had lower odds of having candida stomatitis (adjusted odds ratio (OR) = 0.68, p = 0.0035) and oral hairy leukoplakia (adjusted OR = 0.67, p = 0.033) when compared to MTB uninfected patients.

In conclusion, the study demonstrated that LTBI was associated with a reduced HIV SPVL and fewer cases of the most prevalent OIs on a population level. These associations were robust to adjusting for the most important demographic and clinical confounders. Independently, various sensitivity analyses further strengthened these observations. These findings support the hypothesis that LTBI can benefit host immune responses and provides new avenues for future research to continue to unravel the complex interactions between mycobacteria and humans.