Where is the greatest impact of uncontrolled HIV infection on AIDS and non-AIDS events in HIV?

OBJECTIVE: The extent to which controlled and uncontrolled HIV interact with ageing, European region of care and calendar year of follow-up is largely unknown.

METHODS: EuroSIDA particpants were followed after 1/1/2001 and grouped according to current HIV progression risk; high risk [CD4 ≤350/mm, viral load ≥10,000 copies/ml], low risk [CD4 ≥500/mm, viral load <50 copies/ml], and intermediate [other combinations]. Poisson regression investigated interactions between HIV progression risk, age, European region of care, and year of follow-up and incidence of AIDS or non-AIDS events.

RESULTS: 16839 persons were included with 136688 PYFU. In persons aged ≤30, those at high risk had a 6-fold increased incidence of non-AIDS compared to those at low risk, compared to a 2-3 fold increase in older persons (p=0.0004, interaction). In Eastern Europe; those at highest risk of non-AIDS had a 12-fold increased incidence compared to a 2-4-fold difference in all other regions (p = 0.0029, interaction). Those at high risk of non-AIDS during 2001-2004 had a 2-fold increased incidence compared to those at low risk, increasing to a 5-fold increase ≥2013 (p < 0.0001, interaction). Differences between high, intermediate and low risk of AIDS were similar across age groups, year of follow-up and Europe (p = 0.57, p = 0.060, p = 0.090 respectively, interaction).

CONCLUSIONS: Factors other than optimal control of HIV become increasingly important with ageing for predicting non-AIDS while differences across Europe reflect differences in patient management as well as underlying socioeconomic circumstances. The difference between those at high, intermediate and low risk of non-AIDS ≥2013 likely reflects better quality of care.