Where is the greatest impact of uncontrolled HIV infection on AIDS and non-AIDS events in HIV? AIDS
Mocroft et al. for the EuroSIDA Study aimed to identify whether risk of HIV disease progression comparing controlled and uncontrolled HIV was different across age groups, year of follow-up or European regions of care between 2001 and 2016.
EuroSIDA participants were followed after 1 January 2001 and grouped according to current HIV progression risk: high risk (CD4+ cell count ≤350/ml, viral load ≥10 000 copies/ml), low risk (CD4+ cell count ≥500 cells/ml, viral load <50 copies/ml) and intermediate (other combinations).
A total of 16’839 persons were included with 136’688 person-years of follow-up.
• In persons ≤30 years, those at high risk had a six-fold increased incidence of non-AIDS events compared with those at low risk, compared with a two-to-three-fold increase in older persons (P=0.0004, interaction).
• In Eastern Europe, those at highest risk of non-AIDS events had a 12-fold increased incidence compared with a two-to-four-fold difference in all other regions (P=0.0029, interaction).
• Those at high risk of non-AIDS events during 2001–2004 had a two-fold increased incidence compared with those at low risk, increasing to a five-fold increase between 2013 and 2016 (P<0.0001, interaction).
• Differences among high, intermediate and low risk of AIDS were similar across age groups, year of follow-up and Europe (P=0.57, 0.060 and 0.090, respectively, interaction).
In conclusion, the study-results highlight that as person’s age, factors other than optimal control of HIV become more important for predicting non-AIDS events, demonstrating the role of biological ageing, whereas the development of AIDS is much more dependent on uncontrolled HIV in all age groups.