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7‐11 November 2010, Tenth International Congress on Drug Therapy in HIV Infection, Glasgow, UK

In HIV‐positive patients (pts), CMV co‐infection has been proposed as a key factor in sustaining immune activation, which in turn could play a role in determining immune senescence. We evaluated the prevalence and predictors of CMV co‐infection in a cohort of HIV+ pts and assessed the impact of CMV co‐infection on the risk of AIDS and non‐AIDS events. We included pts in the ICONA study with<1 month follow‐up and<1 CMVIgG (CMV) test available without active CMV disease. Pts' characteristics at time of the first CMV test (baseline) were compared in those tested positive (CMV+) and negative (CMV‐) using X2/Wilcoxon tests. Factors associated with CMV+ were identified by logistic regression. A prospective analysis was also performed with endpoints AIDS/AIDS‐related death and severe non‐AIDS (SNA: cardio‐cerebrovascular, neurologic disease, renal failure, non‐AIDS tumours)/death due to SNA. Time to event was estimated by Kaplan‐Meier curves and Cox regression (multivariable model included: age, gender, ethnicity, risk factor for HIV, HCVAb and HBsAg, AIDS and CD4 at baseline, initiation of ART prior to baseline). 6,053 pts were included; 83.7% were tested CMV+ a median of 17 (IQR 6–45) months after enrolment. As compared to CMV‐, CMV+ were older (adjusted odds ratio (AOR) 1.03 per 1 year older [95% CI 1.02–1.04]), HIV infected by homosexual route (MSM) (AOR 1.39 [95% CI 1.06–1.82]), less frequently Caucasian (AOR 0.56 [95% CI 0.42–0.76]), with higher CD4 count at baseline (AOR per 1 cell higher 1.035 [95% CI 1.00–1.06] By 10 years from first CMV test, 402 (12.6% [95% CI 11.1–13.6]) CMV+ and 74 (10.1% [95% CI 7.7–12.5]) CMV‐ pts developed AIDS/AIDS‐related death (log‐rank p=0.43). After adjustment for potential confounders, CMV+was still not associated with the risk of AIDS/AIDS‐related death (adjusted hazard ratio (AHR) 1.23 [95% CI 0.96–1.60]). By 10 years, 339 (10.6% [95% CI 9.4–11.9]) CMV+ and 41 (6.4% [95% CI 6.1–6.6]) CMV‐ pts experienced a non‐AIDS event/non‐AIDS death (log‐rank p=0.0006): 151 cancers, 128 CVD, 33 neurological, 1 renal. The association was still significant after controlling for a number of potential confounders: AHR 1.77 [95% CI 1.25–2.51] p=0.001; Table). In our study population, CMV/HIV co‐infection was associated with the risk of non‐AIDS events/deaths independently of other prognostic factors, supporting a potential role of CMV infection in vascular/ degenerative organ disorders commonly associated with chronic immune activation and aging.









Characteristic
AHR
95% CI
p‐value




CMVIgg+vs. CMVIgg−
1.77
1.25–2.51
0.001


Age, per 10 years older
1.64
1.46–1.84
0.0001


Female vs. male
1.43
1.12–1.83
0.004


Caucasian vs. Other
0.64
0.40–1.02
0.06


Homosexuals vs. IVDU
0.84
0.55–1.28
0.42


Heterosexuals vs. IVDU
0.87
0.60–1.26
0.47


HCVAb+vs. HCVAb−
1.28
0.92–1.78
0.13


HBsAg+vs HBsAg−
1.05
0.67–1.62
0.83


AIDS at baseline
0.94
0.67–1.32
0.75


CD4/µL at baseline per 100 cells/µL higher
0.97
0.93–1.01
0.16


HIV‐RNA at baseline per log10 cp/mL higher
1.05
0.96–1.16
0.26


Years from HIV diagnosis per 5 years longer
1.02
0.90–1.17
0.69


ART experienced vs. naïve at baseline
0.94
0.66–1.36
0.77

Future scenarios provide challenging, plausible and relevant stories about how the future could unfold. Urban Futures (UF) research has identified a substantial set (>450) of seemingly disparate scenarios published over the period 1997–2011 and within this research, a sub-set of >160 scenarios has been identified (and categorized) based on their narratives according to the structure first proposed by the Global Scenario Group (GSG) in 1997; three world types (Business as Usual, Barbarization, and Great Transitions) and six scenarios, two for each world type (Policy Reform—PR, Market Forces—MF, Breakdown—B, Fortress World—FW, Eco-Communalism—EC and New Sustainability Paradigm—NSP). It is suggested that four of these scenario archetypes (MF, PR, NSP and FW) are sufficiently distinct to facilitate active stakeholder engagement in futures thinking. Moreover they are accompanied by a well-established, internally consistent set of narratives that provide a deeper understanding of the key fundamental drivers (e.g., STEEP—Social, Technological, Economic, Environmental and Political) that could bring about realistic world changes through a push or a pull effect. This is testament to the original concept of the GSG scenarios and their development and refinement over a 16 year period."