BACKGROUND: To estimate the clinical benefit of highly active antiretroviral therapy (HAART) initiation vs deferral in a given month in patients with CD4 cell counts less than 800/μL. METHODS: In this observational cohort study of human immunodeficiency virus type 1 seroconverters from CASCADE (Concerted Action on SeroConversion to AIDS and Death in Europe), we constructed monthly sequential nested subcohorts between January 1996 and May 2009, including all eligible HAART-naive, AIDS-free individuals with a CD4 cell count less than 800/μL. The primary outcome was time to AIDS or death in those who initiated HAART in the baseline month compared with those who did not, pooled across subcohorts and stratified by CD4 cell count. Using inverse probability-of-treatment weighted survival curves and Cox proportional hazards regression models, we estimated the absolute and relative effects of treatment with robust 95% confidence intervals (CIs). RESULTS: Of 9455 patients with 52,268 person-years of follow-up, 812 (8.6%) developed AIDS and 544 (5.8%) died. In CD4 cell count strata of 200 to 349, 350 to 499, and 500 to 799/μL, HAART initiation was associated with adjusted hazard ratios (95% CIs) for AIDS/death of 0.59 (0.43-0.81), 0.75 (0.49-1.14), and 1.10 (0.67-1.79), respectively. In the analysis of all-cause mortality, HAART initiation was associated with adjusted hazard ratios (95% CIs) of 0.71 (0.44-1.15), 0.51 (0.33-0.80), and 1.02 (0.49-2.12), respectively. Numbers needed to treat (95% CIs) to prevent 1 AIDS event or death within 3 years were 21 (14-38) and 34 (20-115) in CD4 cell count strata of 200 to 349 and 350 to 499/μL, respectively. CONCLUSION: Compared with deferring in a given month, HAART initiation at CD4 cell counts less than 500/μL (but not 500-799/μL) was associated with slower disease progression.
BACKGROUND: To estimate the clinical benefit of highly active antiretroviral therapy (HAART) initiation vs deferral in a given month in patients with CD4 cell counts less than 800/μL. METHODS: In this observational cohort study of human immunodeficiency virus type 1 seroconverters from CASCADE (Concerted Action on SeroConversion to AIDS and Death in Europe), we constructed monthly sequential nested subcohorts between January 1996 and May 2009, including all eligible HAART-naive, AIDS-free individuals with a CD4 cell count less than 800/μL. The primary outcome was time to AIDS or death in those who initiated HAART in the baseline month compared with those who did not, pooled across subcohorts and stratified by CD4 cell count. Using inverse probability-of-treatment weighted survival curves and Cox proportional hazards regression models, we estimated the absolute and relative effects of treatment with robust 95% confidence intervals (CIs). RESULTS: Of 9455 patients with 52,268 person-years of follow-up, 812 (8.6%) developed AIDS and 544 (5.8%) died. In CD4 cell count strata of 200 to 349, 350 to 499, and 500 to 799/μL, HAART initiation was associated with adjusted hazard ratios (95% CIs) for AIDS/death of 0.59 (0.43-0.81), 0.75 (0.49-1.14), and 1.10 (0.67-1.79), respectively. In the analysis of all-cause mortality, HAART initiation was associated with adjusted hazard ratios (95% CIs) of 0.71 (0.44-1.15), 0.51 (0.33-0.80), and 1.02 (0.49-2.12), respectively. Numbers needed to treat (95% CIs) to prevent 1 AIDS event or death within 3 years were 21 (14-38) and 34 (20-115) in CD4 cell count strata of 200 to 349 and 350 to 499/μL, respectively. CONCLUSION: Compared with deferring in a given month, HAART initiation at CD4 cell counts less than 500/μL (but not 500-799/μL) was associated with slower disease progression.
Authors: Stephen R Cole; Rui Li; Kathryn Anastos; Roger Detels; Mary Young; Joan S Chmiel; Alvaro Muñoz Journal: Stat Med Date: 2004-11-15 Impact factor: 2.373
Authors: D W Cameron; M Heath-Chiozzi; S Danner; C Cohen; S Kravcik; C Maurath; E Sun; D Henry; R Rode; A Potthoff; J Leonard Journal: Lancet Date: 1998-02-21 Impact factor: 79.321
Authors: F J Palella; K M Delaney; A C Moorman; M O Loveless; J Fuhrer; G A Satten; D J Aschman; S D Holmberg Journal: N Engl J Med Date: 1998-03-26 Impact factor: 91.245
Authors: S M Hammer; K E Squires; M D Hughes; J M Grimes; L M Demeter; J S Currier; J J Eron; J E Feinberg; H H Balfour; L R Deyton; J A Chodakewitz; M A Fischl Journal: N Engl J Med Date: 1997-09-11 Impact factor: 91.245
Authors: Lauren E Cain; Roger Logan; James M Robins; Jonathan A C Sterne; Caroline Sabin; Loveleen Bansi; Amy Justice; Joseph Goulet; Ard van Sighem; Frank de Wolf; Heiner C Bucher; Viktor von Wyl; Anna Esteve; Jordi Casabona; Julia del Amo; Santiago Moreno; Remonie Seng; Laurence Meyer; Santiago Perez-Hoyos; Roberto Muga; Sara Lodi; Emilie Lanoy; Dominique Costagliola; Miguel A Hernan Journal: Ann Intern Med Date: 2011-04-19 Impact factor: 25.391
Authors: Sara Lodi; Andrew Phillips; Roger Logan; Ashley Olson; Dominique Costagliola; Sophie Abgrall; Ard van Sighem; Peter Reiss; José M Miró; Elena Ferrer; Amy Justice; Neel Gandhi; Heiner C Bucher; Hansjakob Furrer; Santiago Moreno; Susana Monge; Giota Touloumi; Nikos Pantazis; Jonathan Sterne; Jessica G Young; Laurence Meyer; Rémonie Seng; Francois Dabis; Marie-Anne Vandehende; Santiago Pérez-Hoyos; Inma Jarrín; Sophie Jose; Caroline Sabin; Miguel A Hernán Journal: Lancet HIV Date: 2015-07-07 Impact factor: 12.767
Authors: Rochelle P Walensky; Eric L Ross; Nagalingeswaran Kumarasamy; Robin Wood; Farzad Noubary; A David Paltiel; Yoriko M Nakamura; Sheela V Godbole; Ravindre Panchia; Ian Sanne; Milton C Weinstein; Elena Losina; Kenneth H Mayer; Ying Q Chen; Lei Wang; Marybeth McCauley; Theresa Gamble; George R Seage; Myron S Cohen; Kenneth A Freedberg Journal: N Engl J Med Date: 2013-10-31 Impact factor: 91.245
Authors: Jessie K Edwards; Stephen R Cole; Daniel Westreich; Michael J Mugavero; Joseph J Eron; Richard D Moore; William C Mathews; Peter Hunt; Carolyn Williams Journal: Clin Infect Dis Date: 2015-06-16 Impact factor: 9.079
Authors: M Platten; R Linnemann; T Kümmerle; N Jung; C Wyen; K Ehren; S Gravemann; D Gillor; O A Cornely; J Fischer; C Lehmann; J K Rockstroh; G Fätkenheuer; J J Vehreschild Journal: Infection Date: 2014-06-26 Impact factor: 3.553
Authors: David B Hanna; Kate Buchacz; Kelly A Gebo; Nancy A Hessol; Michael A Horberg; Lisa P Jacobson; Gregory D Kirk; Mari M Kitahata; P Todd Korthuis; Richard D Moore; Sonia Napravnik; Pragna Patel; Michael J Silverberg; Timothy R Sterling; James H Willig; Bryan Lau; Keri N Althoff; Heidi M Crane; Ann C Collier; Hasina Samji; Jennifer E Thorne; M John Gill; Marina B Klein; Jeffrey N Martin; Benigno Rodriguez; Sean B Rourke; Stephen J Gange Journal: Clin Infect Dis Date: 2013-01-11 Impact factor: 9.079