Response to antiretroviral therapy: improved survival associated with CD4 above 500 cells/μl
Identifieur interne : 003A05 ( Main/Exploration ); précédent : 003A04; suivant : 003A06Response to antiretroviral therapy: improved survival associated with CD4 above 500 cells/μl
Auteurs : David Maman [France] ; Mar Pujades-Rodriguez [France] ; Sarala Nicholas [France] ; Megan Mcguire [France] ; Elisabeth Szumilin [France] ; Rene Ecochard [France] ; Jean-François Etard [France]Source :
- AIDS : (London) [ 0269-9370 ] ; 2012.
Descripteurs français
- Pascal (Inist)
- Wicri :
- topic : Mortalité.
English descriptors
- KwdEn :
Abstract
Objective: We investigated the association between immune response and mortality in four HIV African programs supported by Médecins Sans Frontières. Design: Multicentric retrospective cohort study. Methods: All antiretroviral therapy (ART) naive adults (>15 years) who initiated therapy between March 2001 and November 2010 and receiving therapy for 9 months or more were included. We described the evolution of mortality over time. Mixed Poisson models were used to assess the effect of updated CD4 cell counts and other potential risk factors on mortality. Findings: A total of 24 037 patients, of which 68% were women, contributed 69 516.2 person-years of follow-up. At ART initiation, 5718 patients (23.7%) were classified as WHO clinical stage 4, 1587 (6.6%) had a BMI below 16 kg/m2 and 2568 (10.7%) had CD4 cell count below 50 cells/μl. A total of 568 (2.4%) deaths were recorded during the study period. In the CD4 response categories 500 cells/μl or more, 350-499, 200-349, 50-199 cells/μl and less than 50 cells/μl, unadjusted mortality rates were 0.36; 0.58; 0.88; 1.91 and 7.43 per 100 person-years, respectively. In multivariate analysis, higher mortality was observed in patients with CD4 response levels 350-499 cells/μl [adjusted hazard ratio (aHR) 1.70, 95% confidence interval (CI) 1.26-2.30] and for those between 200-349 (aHR 2.56; 95% CI 1.93-3.38), compared to those with 500 cells/μl or more. Interpretation: The observed higher survival of patients with a CD4 response to ART higher than 500 cells/μl supports the need of further research to evaluate the individual benefit of initiating ART at higher CD4 levels in sub-Saharan Africa.
Affiliations:
- France
- Auvergne-Rhône-Alpes, Languedoc-Roussillon, Occitanie (région administrative), Rhône-Alpes, Île-de-France
- Lyon, Montpellier, Paris
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aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Hospices Civils de Lyon, Service de Biostatistique</s1><s3>FRA</s3><sZ>1 aut.</sZ></inist:fA14><country>France</country><wicri:noRegion>Service de Biostatistique</wicri:noRegion><wicri:noRegion>Hospices Civils de Lyon, Service de Biostatistique</wicri:noRegion></affiliation><affiliation wicri:level="3"><inist:fA14 i1="03"><s1>Université de Lyon</s1><s2>Lyon</s2><s3>FRA</s3><sZ>1 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Auvergne-Rhône-Alpes</region><region type="old region">Rhône-Alpes</region><settlement type="city">Lyon</settlement></placeName></affiliation><affiliation wicri:level="1"><inist:fA14 i1="04"><s1>CNRS UMR5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe 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last="Nicholas">Sarala Nicholas</name><affiliation wicri:level="3"><inist:fA14 i1="01"><s1>Epicentre, 8 rue saint Sabin</s1><s2>Paris</s2><s3>FRA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Mcguire, Megan" sort="Mcguire, Megan" uniqKey="Mcguire M" first="Megan" last="Mcguire">Megan Mcguire</name><affiliation wicri:level="3"><inist:fA14 i1="01"><s1>Epicentre, 8 rue saint Sabin</s1><s2>Paris</s2><s3>FRA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Szumilin, Elisabeth" sort="Szumilin, Elisabeth" uniqKey="Szumilin E" first="Elisabeth" last="Szumilin">Elisabeth Szumilin</name><affiliation wicri:level="3"><inist:fA14 i1="05"><s1>Médecins Sans Frontieres, 8 rue saint Sabin</s1><s2>Paris</s2><s3>FRA</s3><sZ>5 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Ecochard, Rene" sort="Ecochard, Rene" uniqKey="Ecochard R" first="Rene" last="Ecochard">Rene Ecochard</name><affiliation wicri:level="3"><inist:fA14 i1="01"><s1>Epicentre, 8 rue saint Sabin</s1><s2>Paris</s2><s3>FRA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Etard, Jean Francois" sort="Etard, Jean Francois" uniqKey="Etard J" first="Jean-François" last="Etard">Jean-François Etard</name><affiliation wicri:level="3"><inist:fA14 i1="01"><s1>Epicentre, 8 rue saint Sabin</s1><s2>Paris</s2><s3>FRA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation><affiliation wicri:level="3"><inist:fA14 i1="06"><s1>Institut de Recherche pour le Développement (IRD), UMI 233 TransVIHMI, 911 avenue Agropolis</s1><s2>Montpellier</s2><s3>FRA</s3><sZ>7 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Occitanie (région administrative)</region><region type="old region">Languedoc-Roussillon</region><settlement type="city">Montpellier</settlement></placeName></affiliation></author></analytic><series><title level="j" type="main">AIDS : (London)</title><title level="j" type="abbreviated">AIDS : (Lond.)</title><idno type="ISSN">0269-9370</idno><imprint><date when="2012">2012</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">AIDS : (London)</title><title level="j" type="abbreviated">AIDS : (Lond.)</title><idno type="ISSN">0269-9370</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>AIDS</term><term>Antiretroviral agent</term><term>Antiviral</term><term>Chemotherapy</term><term>Epidemiology</term><term>Human immunodeficiency virus</term><term>Mortality</term><term>Prognosis</term><term>Sub-Saharan Africa</term><term>Survival</term><term>T-Lymphocyte</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>SIDA</term><term>Antiviral</term><term>Chimiothérapie</term><term>Antirétroviral</term><term>Survie</term><term>Virus immunodéficience humaine</term><term>Lymphocyte T</term><term>Epidémiologie</term><term>Mortalité</term><term>Afrique subsaharienne</term><term>Pronostic</term><term>Antigène CD4</term></keywords><keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Mortalité</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Objective: We investigated the association between immune response and mortality in four HIV African programs supported by Médecins Sans Frontières. Design: Multicentric retrospective cohort study. Methods: All antiretroviral therapy (ART) naive adults (>15 years) who initiated therapy between March 2001 and November 2010 and receiving therapy for 9 months or more were included. We described the evolution of mortality over time. Mixed Poisson models were used to assess the effect of updated CD4 cell counts and other potential risk factors on mortality. Findings: A total of 24 037 patients, of which 68% were women, contributed 69 516.2 person-years of follow-up. At ART initiation, 5718 patients (23.7%) were classified as WHO clinical stage 4, 1587 (6.6%) had a BMI below 16 kg/m<sup>2</sup> and 2568 (10.7%) had CD4 cell count below 50 cells/μl. A total of 568 (2.4%) deaths were recorded during the study period. In the CD4 response categories 500 cells/μl or more, 350-499, 200-349, 50-199 cells/μl and less than 50 cells/μl, unadjusted mortality rates were 0.36; 0.58; 0.88; 1.91 and 7.43 per 100 person-years, respectively. In multivariate analysis, higher mortality was observed in patients with CD4 response levels 350-499 cells/μl [adjusted hazard ratio (aHR) 1.70, 95% confidence interval (CI) 1.26-2.30] and for those between 200-349 (aHR 2.56; 95% CI 1.93-3.38), compared to those with 500 cells/μl or more. Interpretation: The observed higher survival of patients with a CD4 response to ART higher than 500 cells/μl supports the need of further research to evaluate the individual benefit of initiating ART at higher CD4 levels in sub-Saharan Africa.</div></front></TEI><affiliations><list><country><li>France</li></country><region><li>Auvergne-Rhône-Alpes</li><li>Languedoc-Roussillon</li><li>Occitanie (région administrative)</li><li>Rhône-Alpes</li><li>Île-de-France</li></region><settlement><li>Lyon</li><li>Montpellier</li><li>Paris</li></settlement></list><tree><country name="France"><region name="Île-de-France"><name sortKey="Maman, David" sort="Maman, David" uniqKey="Maman D" first="David" last="Maman">David Maman</name></region><name sortKey="Ecochard, Rene" sort="Ecochard, Rene" uniqKey="Ecochard R" first="Rene" last="Ecochard">Rene Ecochard</name><name sortKey="Etard, Jean Francois" sort="Etard, Jean Francois" uniqKey="Etard J" first="Jean-François" last="Etard">Jean-François Etard</name><name sortKey="Etard, Jean Francois" sort="Etard, Jean Francois" uniqKey="Etard J" first="Jean-François" last="Etard">Jean-François Etard</name><name sortKey="Maman, David" sort="Maman, David" uniqKey="Maman D" first="David" last="Maman">David Maman</name><name sortKey="Maman, David" sort="Maman, David" uniqKey="Maman D" first="David" last="Maman">David Maman</name><name sortKey="Maman, David" sort="Maman, David" uniqKey="Maman D" first="David" last="Maman">David Maman</name><name sortKey="Mcguire, Megan" sort="Mcguire, Megan" uniqKey="Mcguire M" first="Megan" last="Mcguire">Megan Mcguire</name><name sortKey="Nicholas, Sarala" sort="Nicholas, Sarala" uniqKey="Nicholas S" first="Sarala" last="Nicholas">Sarala Nicholas</name><name sortKey="Pujades Rodriguez, Mar" sort="Pujades Rodriguez, Mar" uniqKey="Pujades Rodriguez M" first="Mar" last="Pujades-Rodriguez">Mar Pujades-Rodriguez</name><name sortKey="Szumilin, Elisabeth" sort="Szumilin, Elisabeth" uniqKey="Szumilin E" first="Elisabeth" last="Szumilin">Elisabeth Szumilin</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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