Limiting Cumulative HIV Viremia Copy-Years by Early Treatment Reduces Risk of AIDS and Death
| Autor: | Olson, Ashley D., Walker, A. Sarah, Suthar, Amitabh B., Sabin, Caroline A., Bucher, Heiner C., Jarrín, Inmaculada, Moreno, Santiago, Pérez-Hoyos, Santiago, Porter, Kholoud, Ford, Deborah, Universitat Autònoma de Barcelona |
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| Přispěvatelé: | Unión Europea. Comisión Europea. 7 Programa Marco, Medical Research Council (Reino Unido) |
| Rok vydání: | 2016 |
| Předmět: |
0301 basic medicine
Cart Adult Male medicine.medical_specialty Adolescent Viremia copy-years Human immunodeficiency virus (HIV) CD4 cell count Viremia HIV Infections medicine.disease_cause when to start 03 medical and health sciences Young Adult cART initiation 0302 clinical medicine Acquired immunodeficiency syndrome (AIDS) When to start Internal medicine medicine Humans Pharmacology (medical) 030212 general & internal medicine Young adult Seroconversion seroconverters viremia copy-years Acquired Immunodeficiency Syndrome business.industry Proportional hazards model Hazard ratio CART initiation virus diseases Epidemiology and Prevention Middle Aged medicine.disease 030112 virology 3. Good health CD4 Lymphocyte Count Seroconverters Infectious Diseases HIV-RNA Immunology ComputingMethodologies_DOCUMENTANDTEXTPROCESSING Female business |
| Zdroj: | Journal of Acquired Immune Deficiency Syndromes (1999) Repositorio Institucional de la Consejería de Sanidad de la Comunidad de Madrid Consejería de Sanidad de la Comunidad de Madrid Repisalud Instituto de Salud Carlos III (ISCIII) Dipòsit Digital de Documents de la UAB Universitat Autònoma de Barcelona |
| ISSN: | 1944-7884 |
| Popis: | Supplemental Digital Content is Available in the Text. Background: Viremia copy-years (VCY), a time-updated measure of cumulative HIV exposure, predicts AIDS/death; although its utility in deciding when to start combination antiretroviral therapy (cART) remains unclear. We aimed to assess the impact of initiating versus deferring cART on risk of AIDS/death by levels of VCY both independent of and within CD4 cell count strata ≥500 cells per cubic millimeter. Methods: Using Concerted Action on Seroconversion to AIDS and Death in Europe (CASCADE) data, we created a series of nested “trials” corresponding to consecutive months for individuals ≥16 years at seroconversion after 1995 who were cART-naive and AIDS-free. Pooling across all trials, time to AIDS/death by CD4, and VCY strata was compared in those initiating vs. deferring cART using Cox models adjusted for: country, sex, risk group, seroconversion year, age, time since last HIV-RNA, and current CD4, VCY, HIV-RNA, and mean number of previous CD4/HIV-RNA measurements/year. Results: Of 9353 individuals, 5312 (57%) initiated cART and 486 (5%) acquired AIDS/died. Pooling CD4 strata, risk of AIDS/death associated with initiating vs. deferring cART reduced as VCY increased. In patients with high CD4 cell counts, ≥500 cells per cubic millimeter, there was a trend for a greater reduction for those initiating vs. deferring with increasing VCY (P = 0.09), with the largest benefit in the VCY ≥100,000 copy-years/mL group [hazard ratio (95% CI) = 0.41 (0.19 to 0.87)]. Conclusions: For individuals with CD4 ≥500 cells per cubic millimeter, limiting the cumulative HIV burden to |
| Databáze: | OpenAIRE |
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