Immunodeficiency at the start of antiretroviral therapy in ...

Immunodeficiency at the start of antiretroviral therapy in ...

Immunodeficiency at the start of antiretroviral therapy in low-, middle- and high-income countries Nanina Anderegg, Ole Kirk for the IeDEA & COHERE consortia 24.07.2017 I MI T AMACS ECS- Mo the rs & ECS - I nf an ts NSHPC - Mo thers & NHP S- I n fan ts PI SCI S KOMP NE T C ASC ADE A NR S CO2 SE ROCO Fr a nk fu r t HI V Co ho r t St udy San Ra ffa e le ANRS CO1/ CO10 EPF UK CHI C Athena I TLR-Mothers & I TLR-I nfants Swiss HI V Cohort Study I CC ANRS CO6 PRI MO Co-RI S MOCHI V-Mothers & MoCHI V-I nfants The I talian MASTER Cohort CHI PS ANRS CO4 French Hospitals Database on HI V HI V-MI P- Mothers & HI V-MI P-I nfants GE MES- H aemo A NR S C O3 AQUI TAI NE E u ro SI DA Madri d Co ho r t HI V Children VACH Mo den a C o h o r t S tu dy D an i s h H I V Stu dy A NR S CO 8 C O PI LOT E I CON A St. P i er r e Collaboration of Observational HI V Epidemiological Research Europe Coordination: Copenhagen HI V Programme (CHI P) & I nstitut de Sant Publique,d'Epidmiologie et de Dveloppement (I SPED) 1 conflict of interest No conflicts of interest to declare. 2 background

3 background in an ideal world in the real world delayed implementation of guidelines late presentation / diagnosis how far off are we in the real 4 aim Description of temporal trends in the CD4 cell count at initiation of cART in adults in low-, middle- and high-income countries 5 methods - data routine HIV data from 2 large collaborations: IeDEA International epidemiology Databases to Evaluate AIDS 7 regions (4 in sub-Saharan Africa, AsiaPacific, Latin America, North America) COHERE

Collaboration of Observational HIV Epidemiological Research in Europe 6 methods - analysis adults, cART start 2002 2015 multiple imputation of missing CD4 cell counts aggregation by country, calendar year, sex: median CD4 cell count % severe immunodeficiency (< 200 cells/L) estimation of time trends of outcomes by 7 results - descriptive statistics 8 results - descriptive statistics LIC LMIC UMIC HIC

Overall Countrie s 16 11 9 19 55 Patients 196,143 526,390 81,958 153,424 951,857 Female

64% 63% 60% 25% 57% Median age (IQR) [years] 35 (29-42) 35 (29-42) 35 (29-42) 39 (32-47) 35 (30-43)

Median cART start (IQR) 2010 (20082013) 2010 (20082013) 2010 (20072013) 2008 (20052011) 2010 (20072012) CD4 missing 45% 33% 27% 23%

33% 9 results - median CD4 highest increases: UMIC, LIC, LMIC, HIC larger increase in females (except HIC) 10 results - severe immunodeficiency largest decreases: LIC, UMIC, HIC, LMIC larger decreases in females (except HIC) 11 summary median CD4 cell count at cART start overall increase 2015: < 350 cells/L in all income groups severe immunodeficiency at cART start overall decrease 2015: > 25% severe immunodeficiency in all income groups

plateaus in HIC 12 how far off are we...? in an ideal world: Question: how far off are we in the real world? 13 how far off are we...? Question: how far off are we in the real world? Answer: quite a bit! 13 conclusion Substantial additional efforts and resources are needed to increase testing coverage with the aim of achieving earlier diagnosis, linkage to care, and initiation of cART globally 14

acknowledgements Sponsoring Institutions Regions and PIs Funding The International Epidemiology Asia-Pacific Databases to Evaluate AIDS Annette Sohn (amfAR TREAT Asia) National Institute of (IeDEA) is supported by the U.S. Matthew Law (University of New South Allergy and Infectious National Institutes of Healths Wales) Diseases (NIAID) National Institute of Allergy and CCASAnet Carolyn Williams, Cathy McGowan (Vanderbilt University) Infectious Diseases, the Eunice Melanie Bacon, Robin Kennedy Shriver National Pedro Cahn (Fundacin Husped, Huebner, Rosemary Institute of Child Health and Argentina)

McKaig, Gerald Sharp, Human Development, the Lori Zimand Central Africa National Cancer Institute, the Kathryn Anastos (Albert Einstein Eunice Kennedy National Institute of Mental College of Medicine) Shriver National Health, and the National Institute Denis Nash (CUNY School of Public Institute for Child on Drug Abuse: Asia-Pacific, Health) Health Development U01AI069907; CCASAnet, East Africa (NICHD) U01AI069923; Central Africa, Kara Wools-Kaloustian (Indiana Rohan Hazra U01AI096299; East Africa, University) U01AI069911; NA-ACCORD, National Cancer Constantin Yiannoutsos (Indiana U01AI069918; Southern Africa,

Institute (NCI) University) U01AI069924; West Africa, Geraldina Dominguez NA-ACCORD U01AI069919. This work is solely National Institute of Richard Moore (Johns Hopkins the responsibility of the authors Mental Health (NIMH) University) and does not necessarily represent the official views of Project Working Group Southern Africa Pim Brouwers any ofKeri the Althoff, governments or Nanina Anderegg, Klea Panayidou, Matthias Matthias Egger Egger, (University Yao Abo, of Bern) Kathryn Anastos, Eric Balestre,

National Institute on institutions mentioned above. Renaud Becquet, Barbara Castelnuovo, Mary-AnnLara Davies Coelho, (University BrandaofCrabtree-Ramirez, Cape Mary-Ann Davies, Nicole Drug Abuse (NIDA) De La Mata, Stephany Duda, Aime Town) Freeman, Stephen Gange, Awachana Jiamsakul, Mari Kitahata Matthew Katherine Davenny 15 Larry Law, Catherine McGowan, Richard Moore, West Africa Gertrude Nakigozi, Denis Nash, Oon Tek Ng, Armel Poda, Riggen, Jean dAmour Sinayobye, Christelle

Francois DabisTwizere, (ISPED)Kara Wools-Kaloustian, Marcel Yotebieng. I MI T A MACS E CS- Mo thers & ECS - I nf ants NSHPC- Mo thers & NHP S- I n fan ts PI SCI S acknowledgements Project leaders and statistical analysis Regional Coordinating Centres Juan Berenguer, Julia Bohlius, Vincent Bouteloup, Heiner Bucher, Alessandro Cozzi-Lepri, Franois Dabis, Antonella dArminio Monforte, Mary-Anne Davies, Julia del Amo, Maria Dorrucci, David Dunn, Matthias Egger, Hansjakob Furrer, Marguerite Guiguet, Sophie Grabar, Ali Judd, Ole Kirk, Olivier Lambotte, Valriane Leroy, Sara Lodi, Sophie Matheron, Laurence Meyer, Jose M Mir, Amanda Mocroft, Susana Monge, Fumiyo Nakagawa,

Roger Paredes, Andrew Phillips, Massimo Puoti, Michael Schomaker, Colette Smit, Jonathan Sterne, Rodolphe Thiebaut, Claire Thorne, Carlo Torti, Marc van der Valk, Linda Sources of funding Wittkop. Bordeaux RCC: Diana Barger, Christine Schwimmer, Monique Termote, Linda Wittkop; Copenhagen RCC: Maria Campbell, Casper M. Frederiksen, Nina Friis-Mller, Jesper Kjaer, Dorthe Raben, Project Group Rikke SalblWorking Brandt. The COHERE study group has received unrestricted funding from: Agence Nationale de Recherches sur le SIDA et les Hpatites Virales (ANRS),

France; HIV Monitoring Foundation, the Netherlands; and the Augustinus Foundation, Denmark. The research leading to these results has received funding from the European Union Seventh Framework Programme (FP7/2007-2013) under EuroCoord grant agreement n 260694. A list of the funders of the participating cohorts can be found on the Regional Coordinating Centre websites at http://www.cphiv.dk/COHERE/tabid/29 5/Default.aspx and http://etudes.isped.u-bordeaux2.fr/coh Ole Kirk, Belen Alejos, Andrea Antinori, Barbara Bartmeyer, Antonella Castagna, Genevive Chne, Dominique Costagliola, Jeannie Collins, Francois Dabis, Antonella dArminio Monforte, Valerie Delpech, Katharina Grabmeier-Pfistershammer, Christian Manzardo, Laurence Meyer, Cristina Mussini, Niels Obel, Nikos Pantazis, Dorthe Raben, Peter Reiss, Caroline Sabin, Anders Snnerborg, Marcel Stoeckle, Claire Thorne, Carlo Torti, JanChristian Wasmuth, Linda Wittkop,

Executive Committee Stephane De Wit. Stphane de Wit (Chair, St. Pierre University Hospital), Jose M. Mir (PISCIS), Dominique Costagliola (FHDH), Antonella dArminio-Monforte (ICONA), Antonella Castagna (San Raffaele), Julia del Amo (CoRIS), Amanda Mocroft (EuroSida), Dorthe Raben (Head, Copenhagen Regional Coordinating Centre), Genevive Chne (Head, Bordeaux Regional Coordinating Centre) KO MP NET C ASC A DE A NR S CO2 SE ROCO Fr ankfu r t HI V Co ho rt St ud y San R affae le ANRS CO1/ CO10 EPF UK CHI C Athena I TLR-Mothers & I TLR-I nfants Swiss HI V Cohort Study I CC ANRS CO6 PRI MO Co-RI S MOCHI V-Mothers & MoCHI V-I nfants The I talian MASTER Cohort CHI PS ANRS CO4 French Hospitals Database on HI V HI V-MI P- Mothers & HI V-MI P-I nfants GE MES- H ae mo A NR S CO3 AQUI TA I NE E u ro SI DA Mad ri d Co ho r t HI V Chil dren VACH Mo d en a C o h o r t Stu d y D an i s h H I V Stu d y A N R S CO 8 C O PI LOT E I CO NA St. P i e rr e Collaboration of Observational HI V Epidemiological Research Europe

Coordination: Copenhagen HI V Programme (CHI P) & I nstitut de Sant Publique,d'Epidmiologie et de Dveloppement (I SPED) Steering committee Contributing Cohorts: Ali Judd (AALPHI) Robert Zangerle (AHIVCOS),Giota Touloumi (AMACS), Josiane Warszawski (ANRS CO1 EPF/ANRS CO11 OBSERVATOIRE EPF), Laurence Meyer (ANRS CO2 SEROCO), Franois Dabis (ANRS CO3 AQUITAINE), Murielle Mary Krause (ANRS CO4 FHDH), Jade Ghosn (ANRS CO6 PRIMO), Catherine Leport (ANRS CO8 COPILOTE), Linda Wittkop (ANRS CO13 HEPAVIH), Peter Reiss (ATHENA), Ferdinand Wit (ATHENA), Maria Prins (CASCADE), Heiner Bucher (CASCADE), Diana Gibb (CHIPS), Gerd Ftkenheuer (Cologne-Bonn), Julia Del Amo (CoRIS), Niels Obel (Danish HIV Cohort), Claire Thorne (ECS), Amanda Mocroft (EuroSIDA), Ole Kirk (EuroSIDA), Christoph Stephan (Frankfurt), Santiago Prez-Hoyos (GEMES-Haemo), Osamah Hamouda (German ClinSurv), Barbara Bartmeyer (German ClinSurv),

Nikoloz Chkhartishvili (Georgian National HIV/AIDS), Antoni Noguera-Julian (CORISPE-cat), Andrea Antinori (ICC), Antonella dArminio Monforte (ICONA), Norbert Brockmeyer (KOMPNET), Luis Prieto (Madrid PMTCT Cohort), Pablo Rojo Conejo (CORISPES-Madrid), Antoni SorianoArandes (NENEXP), Manuel Battegay (SHCS), Roger Kouyos (SHCS), Cristina Mussini (Modena Cohort), Pat Tookey (NSHPC), Jordi Casabona (PISCIS), Jose M. Mir (PISCIS), Antonella Castagna (San Raffaele), Deborah Konopnick (St. Pierre Cohort), Tessa Goetghebuer (St Pierre Paediatric Cohort), Anders Snnerborg (Swedish InfCare), Carlo Torti (The Italian 16 CHIC), Master Cohort), Caroline Sabin (UK Ramon Teira (VACH), Myriam Garrido (VACH). thank you & questions? 17

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