Importance of Baseline Prognostic Factors With Increasing Time Since Initiation of Highly Active Antiretroviral Therapy
Identifieur interne : 001897 ( Pmc/Corpus ); précédent : 001896; suivant : 001898Importance of Baseline Prognostic Factors With Increasing Time Since Initiation of Highly Active Antiretroviral Therapy
Auteurs :Source :
- Journal of acquired immune deficiency syndromes (1999) [ 1525-4135 ] ; 2007.
Abstract
The extent to which the prognosis for AIDS and death of patients initiating highly active antiretroviral therapy (HAART) continues to be affected by their characteristics at the time of initiation (baseline) is unclear.
We analyzed data on 20,379 treatment-naive HIV-1–infected adults who started HAART in 1 of 12 cohort studies in Europe and North America (61,798 person-years of follow-up, 1844 AIDS events, and 1005 deaths).
Although baseline CD4 cell count became less prognostic with time, individuals with a baseline CD4 count <25 cells/µL had persistently higher progression rates than individuals with a baseline CD4 count >350 cells/µL (hazard ratio for AIDS = 2.3, 95% confidence interval [CI]: 1.0 to 2.3; mortality hazard ratio = 2.5, 95% CI: 1.2 to 5.5, 4 to 6 years after starting HAART). Rates of AIDS were persistently higher in individuals who had experienced an AIDS event before starting HAART. Individuals with presumed transmission by means of injection drug use experienced substantially higher rates of AIDS and death than other individuals throughout follow-up (AIDS hazard ratio = 1.6, 95% CI: 0.8 to 3.0; mortality hazard ratio = 3.5, 95% CI: 2.2 to 5.5, 4 to 6 years after starting HAART).
Compared with other patient groups, injection drug users and patients with advanced immunodeficiency at baseline experience substantially increased rates of AIDS and death up to 6 years after starting HAART.
Url:
DOI: 10.1097/QAI.0b013e31815b7dba
PubMed: 18043315
PubMed Central: 3687569
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<front><journal-meta><journal-id journal-id-type="nlm-journal-id">100892005</journal-id><journal-id journal-id-type="pubmed-jr-id">21821</journal-id><journal-id journal-id-type="nlm-ta">J Acquir Immune Defic Syndr</journal-id><journal-id journal-id-type="iso-abbrev">J. Acquir. Immune Defic. Syndr.</journal-id><journal-title-group><journal-title>Journal of acquired immune deficiency syndromes (1999)</journal-title></journal-title-group><issn pub-type="ppub">1525-4135</issn><issn pub-type="epub">1944-7884</issn></journal-meta><article-meta><article-id pub-id-type="pmid">18043315</article-id><article-id pub-id-type="pmc">3687569</article-id><article-id pub-id-type="doi">10.1097/QAI.0b013e31815b7dba</article-id><article-id pub-id-type="manuscript">NIHMS411059</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>Importance of Baseline Prognostic Factors With Increasing Time Since Initiation of Highly Active Antiretroviral Therapy</article-title><subtitle>Collaborative Analysis of Cohorts of HIV-1–Infected Patients</subtitle></title-group><contrib-group><contrib contrib-type="author"><collab>Antiretroviral Therapy Cohort Collaboration<xref ref-type="fn" rid="FN1">*</xref></collab></contrib></contrib-group><author-notes><corresp id="cor1">Correspondence to: Jonathan A. C. Sterne, MA, MSc, PhD, Department of Social Medicine, University of Bristol, Canynge Hall, Whiteladies Road, Bristol, BS8 2PR UK (<email>jonathan.sterne@bristol.ac.uk</email>)</corresp></author-notes><pub-date pub-type="nihms-submitted"><day>1</day><month>10</month><year>2012</year></pub-date><pub-date pub-type="ppub"><day>15</day><month>12</month><year>2007</year></pub-date><pub-date pub-type="pmc-release"><day>20</day><month>6</month><year>2013</year></pub-date><volume>46</volume><issue>5</issue><fpage>607</fpage><lpage>615</lpage><permissions><copyright-statement>Copyright © 2007 by Lippincott Williams & Wilkins</copyright-statement><copyright-year>2007</copyright-year></permissions><abstract><sec id="S1"><title>Background</title><p id="P1">The extent to which the prognosis for AIDS and death of patients initiating highly active antiretroviral therapy (HAART) continues to be affected by their characteristics at the time of initiation (baseline) is unclear.</p></sec><sec id="S2"><title>Methods</title><p id="P2">We analyzed data on 20,379 treatment-naive HIV-1–infected adults who started HAART in 1 of 12 cohort studies in Europe and North America (61,798 person-years of follow-up, 1844 AIDS events, and 1005 deaths).</p></sec><sec id="S3"><title>Results</title><p id="P3">Although baseline CD4 cell count became less prognostic with time, individuals with a baseline CD4 count <25 cells/µL had persistently higher progression rates than individuals with a baseline CD4 count >350 cells/µL (hazard ratio for AIDS = 2.3, 95% confidence interval [CI]: 1.0 to 2.3; mortality hazard ratio = 2.5, 95% CI: 1.2 to 5.5, 4 to 6 years after starting HAART). Rates of AIDS were persistently higher in individuals who had experienced an AIDS event before starting HAART. Individuals with presumed transmission by means of injection drug use experienced substantially higher rates of AIDS and death than other individuals throughout follow-up (AIDS hazard ratio = 1.6, 95% CI: 0.8 to 3.0; mortality hazard ratio = 3.5, 95% CI: 2.2 to 5.5, 4 to 6 years after starting HAART).</p></sec><sec id="S4"><title>Conclusions</title><p id="P4">Compared with other patient groups, injection drug users and patients with advanced immunodeficiency at baseline experience substantially increased rates of AIDS and death up to 6 years after starting HAART.</p></sec></abstract><kwd-group><kwd>AIDS</kwd><kwd>CD4 counts</kwd><kwd>highly active antiretroviral therapy</kwd><kwd>HIV</kwd><kwd>prognosis</kwd><kwd>substance abuse (intravenous)</kwd></kwd-group><funding-group><award-group><funding-source country="United States">National Institute on Alcohol Abuse and Alcoholism : NIAAA</funding-source><award-id>U24 AA020794 || AA</award-id></award-group></funding-group></article-meta></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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