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ART and toxicities: CNS

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Presentation on theme: "ART and toxicities: CNS"— Presentation transcript:

1 ART and toxicities: CNS

2 Aims of studies Incidence and survival of CNS opportunistic diseases 1996 – 2007 - HIV encephalopathy, PML, toxoplasmosis and cryptococcal meningitis CPE score of cART prescribed between - association between CPE score and demographics or clinical parameters - assess if higher CPE scores associated with reduced incidence of CNS opportunistic diseases and longer survival UK Collaborative HIV Cohort (CHIC) Study Observational cohort initiated in Dataset currently includes 32,607 patients from 10 UK centres

3 Incidence of CNS diseases 1996 - 2007
Number of subjects Incidence rate per 1000 PY 13.1 4.3 3.4 3.3 2.3 1.0

4 Survival of CNS diseases
PML HIVe TOXO CRYP 5 year survival estimates PML HIVe TOXO CRYP 46.5% 59.8% 70.4% 71.4%

5 Median CPE score (2010) of cART
Median (IQR) CPE score 1996/97 1998/99 2000/01 2002/03 2004/05 2006/08

6 CPE (2010) score % subjects CPE score CPE score of cART
Majority of subjects (80%) started cART with a CPE score of 5-9 % subjects But 1998 (approx 10%) did not CPE score

7 Results – multivariable analysis
Low (4 or less) CPE scores significantly associated* with - Non-white ethnicity Prior ARV-experience Starting cART or Lower pre-treatment plasma CD4+ cell count Older subjects *p< all cases Significant* differences in gender, HIV-risk group and ethnicity existed between CPE strata

8 Results – incidence of CNS diseases
CPE score not significantly associated with incidence of CNS diseases

9 Results – overall survival
Initial CPE score Most recent CPE score Adjusted CPE Score RR (95% CI) p-value <4 1 0.03 0.0001 5-7 0.80 (0.66, 0.97) 0.81 (0.66, 0.98) 8-9 0.78 (0.64, 0.95) 0.80 (0.64, 0.98) >10 0.71 (0.56, 0.89) 0.83 (0.66, 1.04) Off treatment 1.73 (1.40, 2.14)

10 Summary Changes to CPE score of cART regimens over study period in UK CHIC No association between CPE score and development of CNS disease Significant associations observed between latest CPE score and mortality Choice of cART regimen (and therefore CPE score) varies significantly according to clinical status of patient – this should be considered when utilising the CPE score as research tool Observed changes to CPE score of cART prescribed over study period within UK CHIC Significant associations observed between latest CPE score and mortality – likely to reflect individualised prescribing for those deteriorating clinically, or toxicity and complications from complex cART regimens

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