OBJECTIVES: To compare the response to highly active antiretroviral therapy (HAART) in individuals starting HAART at different CD4 cell counts. DESIGN: The mean increase in CD4 cell count and rate of virological failure after commencing HAART were measured in antiretroviral-naive patients (1421) in a large, non-randomized multicentre, observational study in Italy (ICONA). Clinical endpoints were also evaluated in a subset of patients who started HAART with a very low CD4 cell count. RESULTS: After 96 weeks of therapy, the mean rise in CD4 cell count was 280, 281 and 186 x 10(6) cells/l in patients starting HAART with a CD4 cell count < 200, 201--350 and > 350 x 10(6) cells/l, respectively. Patients starting HAART with a CD4 cell count < 200 x 10(6) cells/l tended to have a higher risk of subsequent virological failure [relative hazard (RH), 1.15; 95% confidence interval (CI), 0.93--1.42] compared with patients starting with > 350 x 10(6) cells/l. There was no difference in risk between the 201--350 and the > 350 x 10(6) cells/l groups (RH, 1.0; 95% CI, 0.79--1.29). The incidence of new AIDS-defining diseases/death in patients who started HAART with a CD4 count < 50 was 0.03/person-year (95% CI, 0.10--0.33) during the time in which the patient's CD4 cell count had been raised to > 200 x 10(6) cells/l. CONCLUSIONS: There was no clear immunological or virological advantage in starting HAART at a CD4 cell count > 350 rather than at 200--350 x 10(6) cells/l. The increase in CD4 cells restored by HAART is meaningful in that they are associated with reduced risk of disease/death.
OBJECTIVES: To compare the response to highly active antiretroviral therapy (HAART) in individuals starting HAART at different CD4 cell counts. DESIGN: The mean increase in CD4 cell count and rate of virological failure after commencing HAART were measured in antiretroviral-naive patients (1421) in a large, non-randomized multicentre, observational study in Italy (ICONA). Clinical endpoints were also evaluated in a subset of patients who started HAART with a very low CD4 cell count. RESULTS: After 96 weeks of therapy, the mean rise in CD4 cell count was 280, 281 and 186 x 10(6) cells/l in patients starting HAART with a CD4 cell count < 200, 201--350 and > 350 x 10(6) cells/l, respectively. Patients starting HAART with a CD4 cell count < 200 x 10(6) cells/l tended to have a higher risk of subsequent virological failure [relative hazard (RH), 1.15; 95% confidence interval (CI), 0.93--1.42] compared with patients starting with > 350 x 10(6) cells/l. There was no difference in risk between the 201--350 and the > 350 x 10(6) cells/l groups (RH, 1.0; 95% CI, 0.79--1.29). The incidence of new AIDS-defining diseases/death in patients who started HAART with a CD4 count < 50 was 0.03/person-year (95% CI, 0.10--0.33) during the time in which the patient's CD4 cell count had been raised to > 200 x 10(6) cells/l. CONCLUSIONS: There was no clear immunological or virological advantage in starting HAART at a CD4 cell count > 350 rather than at 200--350 x 10(6) cells/l. The increase in CD4 cells restored by HAART is meaningful in that they are associated with reduced risk of disease/death.
Authors: Nam Su Ku; Young Goo Song; Sang Hoon Han; Sun Bean Kim; Hye-won Kim; Su Jin Jeong; Chang Oh Kim; June Myung Kim; Jun Yong Choi Journal: AIDS Res Hum Retroviruses Date: 2012-06-25 Impact factor: 2.205
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Authors: Hafiza Fizzah Zulfiqar; Aneeqa Javed; Bakht Afroze; Qurban Ali; Khadija Akbar; Tariq Nadeem; Muhammad Adeel Rana; Zaheer Ahmad Nazar; Idrees Ahmad Nasir; Tayyab Husnain Journal: Front Public Health Date: 2017-03-07
Authors: Hermann Bussmann; C William Wester; Kereng V Masupu; Trevor Peter; Sarah M Gaolekwe; Soyeon Kim; Ann Marie Reich; Sam Ahn; Ying Wu; Ibou Thior; Max Essex; Richard Marlink Journal: Clin Diagn Lab Immunol Date: 2004-09
Authors: Mari M Kitahata; Stephen J Gange; Alison G Abraham; Barry Merriman; Michael S Saag; Amy C Justice; Robert S Hogg; Steven G Deeks; Joseph J Eron; John T Brooks; Sean B Rourke; M John Gill; Ronald J Bosch; Jeffrey N Martin; Marina B Klein; Lisa P Jacobson; Benigno Rodriguez; Timothy R Sterling; Gregory D Kirk; Sonia Napravnik; Anita R Rachlis; Liviana M Calzavara; Michael A Horberg; Michael J Silverberg; Kelly A Gebo; James J Goedert; Constance A Benson; Ann C Collier; Stephen E Van Rompaey; Heidi M Crane; Rosemary G McKaig; Bryan Lau; Aimee M Freeman; Richard D Moore Journal: N Engl J Med Date: 2009-04-01 Impact factor: 91.245