Analysis of survival of HIV-infected patients depending on various factors

Purpose of the study: Identification of predictors of survival of HIV-infected patients for further optimization of medical care.

Materials and methods. A retrospective study of data from 458 deceased HIV-infected patients who were registered at the Republican AIDS Center from 2000 to 2021 was conducted. The patient’s age, stage of HIV infection, comorbidity index, duration of follow-­up, duration of ART at the time of the patient’s death and causes of death were analyzed.

Results. ART contributed to an increase in patient life expectancy, with 46.5% of patients aged 40 to 49 years at the time of reaching the end point of life, 23% – from 50 to 59 years, and 8.5% – over 60 years. At the time of death, 11.5% of patients were in the initial stages, 88.5% were in advanced stages of HIV infection (P <0.05). Life expectancy after diagnosis in 28.6% of patients ranged from 1 year to 5 years, in 25.3% – from 6 to 10 years, in 24.6% – from 11 to 15 years, and in 9.1% – from 15 to 20 years. A high comorbidity index was associated with worse patient survival. The median survival in patients with IC scores of 6 or more was 7 years, with IC scores of 1­5 – 6 years, and with IC scores of 0 – 11 years.

Conclusion. For the first time in our country, a survival analysis of HIV-infected patients in long­term follow­up (more than 20 years) was carried out, which revealed that virological effectiveness 13­20 years after the start of ART was established in 95% of patients. It has been established that even with a low initial level of CD4 lymphocytes (<200 cells/μl), positive dynamics occur at the start of ART, but they weaken with life expectancy. The Charlson comorbidity index at detection was high in 59% – 6 or more points, despite the young and middle age of the patients. By the time of death, the comorbidity index had increased. It was found that survival of more than 15 years with ART was in 54% of HIV-infected patients, and without ART in 26% of patients, which shows the need to study factors that make it possible to live without ART.

1. https://www.unaids.org/ru

2. Cohen M.S., Chen Y.Q., McCauley M., Gamble T., Hosseinipour M.C., Kumarasamy N., Hakim J., Kumwenda J., Grinsztejn B., Pilotto J.H., Godbole S.V., Mehendale S., Chariyalertsak S., Santos B.R., Mayer K.H., Hoffman I.F., Eshleman S.H., Piwowar – Manning E., Wang L., Makhema J. Prevention of HIV – 1 infection with early antiretroviral therapy // New England Journal of Medicine. – 2011. – No.365 (6) – P. 493 – 505.3. Thomas C.Q. HIV epidemiology and the effects of antiviral therapy on long – term consequences // AIDS. – 2008. – No.22 (3). – P. 7 – 12.

3. https://www.who.int/

4. Marks G., Crepaz N., Senterfitt JW, Janssen RS. Meta – analysis of high – risk sexual behavior in persons aware and unaware they are infected with HIV in the United States: implications for HIV prevention programs. J Acquir Immune Defic Syndr. 2005 Aug. 1; 39(4):446 – 53. doi: 10.1097/01.qai.0000151079.33935.79. PMID: 16010168.

5. Fisher M. Late diagnosis of HIV infection: major consequences and missed opportunities. Curr. Opin. Infect. Dis. 2008 Feb; 21(1):1 – 3. doi: 10.1097/QCO.0b013e3282f2d8fb. PMID: 18192778.

6. Belyakov N.A. VICH – infekciya, vtorichnye I soputstvuyushchie zabolevaniya / N.A. Belyakov, V.V Rassokhin, E.V. Stepanova // Medicinskij tematicheskij arkhiv. SPb.: Baltijskij medicinskij obrazovatel’nyj centr. – 2014. – No.8. – S. 368.

7. Leonova O.N., Tyazhiolye i komorbidnye sostoyaniya u bol’nykh s VICH – infekciej: analiz neblagopriyatnykh isxodov/ O.N. Leonova, E.V. Stepanova, N.A. Belyakov// VICH – infekci – ya i immunosupressii. – 2017. – T.9. – No.1. – S.55 – 64.

8. D’yachkova E.V. Komorbidnye sostoyaniya pri VICH – infekcii/E.V. D’yachkova, K.S. Kuznecova, M.V. Nikol’skaya //Vestnik Penzenskogo gosudarstvennogo universiteta. – 2019. T.25. – No.1. –S. 64–67.

9. Belyalov F.I. Dvenadcat’ tezisov komorbidnosti /F.I. Belyalov //Klinicheskaya medicina. – 2009. – No.12. – S. 69–71.

10. Ladnaya N.N. Razvitie epidemii VICH – infekcii v region – akh Rossijskoj Federacii v 2007 g./N.N. Ladnaya, E.V. Sokolova, O.G. Yurin [i dr.]// Epidemiologiya I infekcinnye bolezni – 2008. – No.3. – S. 7 – 12.

11. Rakhmanova A.G. Analiz prichin smerti VICH – inficirovannykh v 2008–2010 gg. Po materialam klinicheskoj infekcionnoj bol’nicy im. S.P. Botkina, g.Sankt – Peterburg/ A.G.Rakhmanova [i dr.] //Kazanskij med.zh.. – 2012. – No.3. – S.522 – 526.

12. Pokrovsky V.V. HIV/AIDS reduces the number of russians and their life expectancy// V.V. Pokrovsky, N.N. Ladnaya, A.V. Pokrovskya// Demograficheskoe obozrenie. –2017– No.1.–S.65–82.

13. Ladnaya N.N., Epidemicheskaya situaciya po VICH-infekcii v Rossijskoj Federacii v 2019 g / N.N.Ladnaya, V.V.Pokrovsky,L.A. Dement’eva,E.V. Sokolova // Epidemiologiya I infekcionnye bolezni.Aktual’nye voprosy. – 2020 – T.10. – No.3. – S.17 – 26 . doi: https://dx.doi.org /10.18565/epidem.2020.10.3.17–26.

14. Oleynik A. F. Znachenie komorbidnosti pri VICH – infekcii //A. F. Oleynik, V. X. Fazilov // Infekcionnye bolezni: Novosti, mneniya, obuchenie. – 2017. – T.18/ – No.1. – S. 101 – 108. – DOI: 10.24411/2305–3496–2017–00028.

15. Sharabchiev Yu.T., Komorbidnost–aktualnaya i nauchno – prakticheskaya problema mediciny XXI veka.// Sharabchiev Yu.T., Antipov V.V., Antipova S.I. Medicinskie novosti . –2014. – No. 6. –S.6 – 11.

16. Naumova L.A., Komorbidnost: mekhanizmy patogeneza. klinicheskoe znachenie./ L.A. Naumova, O.N. Osipova // Sovremennye problemy nauki i obrazovaniya. – 2016. – No.5. – S.105.

17. Feinstein A. R. (1970). The pre – therapeutic classification of comorbidity in chronic disease. Journal of Chronic Diseases, 23(7), 455–468. doi:10.1016/0021–9681(70)90054–8.

18. Silberstein S.D., Lipton R.B., Goadsby P.J. (eds). Headache in clinical practice. ISIS. Medical Media; 1998. 213 p.

19. Oleynik A.F. Rol’ komorbidnosti pri VICH – infekcii / A.F. Oleynik, A.T. Beshimov, V.Kh. Fazylov // Materialy yubilejnoj nauchno–prakticheskoj konferencii, posvyashchennoj 100–letiyu zaveduyushchego kafedroj infekcionnykh boleznej KGMU, professora Aleksandra Efimovicha Reznika «Aktual’nye problemy infekcionnykh bolezney (voprosy epidemiologii, kliniki, diagnostiki,lecheniya i profilaktiki)». – Kazan’. – 2016. – S. 36.

20. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987; 40 (5):373 – 383. doi: 10.1016/0021–9681(87)90171–8. PMID: 3558716.

21. Fried L, Bernardini J, Piraino B. Charlson comorbidity index as a predictor of outcomes in incident peritoneal dialysis patients. Am J Kidney Dis. 2001 Feb; 37(2):337 – 42. doi: 10.1053/ajkd.2001.21300. PMID: 11157375.

22. Metodika rascheta indeksa komorbidnosti Charlson. http://boris.bikbov.ru/2010/08/10/metodika–rascheta–indeksa–komorbidnosti–charlson/.

23. Belyakova, N.A. Virus immunodeficita cheloveka – medicina: rukovodstvo dlya vrachej / Pod red. N.A. Belyakova,A.G.Rakhmanovoj. – CPb.: Baltijskij medicinskij obrazovatel’nyj centr. – 2011. – S.656.

24. Khoffmann K., Rokshtro Yu.K.(red.) VICH 2014/2015. Gamburg, Bonn, Germaniya: Medizin Fokus. –2014. S.–924

25. Ar’eva G.T. Komorbidnye i mul’timorbidnye sostoyaniya v geriaatrii (obzor)/ G.T. Ar’eva, N.V. Sovetkina, N.A. Ovsyannikova i dr. // Uspekhi gerontol. – 2011. – No. 4. – S. 612–619.

26. Modestov E.A. Metodicheskie podkhody k kompleksnoj ocenke sostoyaniya zdorov’ya lic pozhilogo i starcheskogo vozrasta/ E.A. Modestov, O.M. Novikov, V.V. Shevchenko i dr. // Sibir.med.obozrenie– 2001. – No. 2. S. 23 –25.