Improved outcomes with earlier initiation of highly active antiretroviral therapy among human immunodeficiency virus-infected patients who achieve durable virologic suppression: Longer follow-up of an observational cohort study

被引:65
作者
Sterling, TR
Chaisson, RE
Keruly, J
Moore, RD
机构
[1] Johns Hopkins Univ, Sch Med, Div Infect Dis, Baltimore, MD 21205 USA
[2] Johns Hopkins Univ, Sch Publ Hlth, Dept Epidemiol, Baltimore, MD 21205 USA
[3] Johns Hopkins Univ, Sch Publ Hlth, Dept Int Hlth, Baltimore, MD USA
关键词
D O I
10.1086/379741
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
On the basis of studies with relatively short follow-up, treatment guidelines currently recommend that highly active antiretroviral therapy (HAART) be initiated in asymptomatic human immunodeficiency virus-infected patients when the CD4(+) lymphocyte count is less than or equal to200 cells/mm(3). We assessed the development of a new opportunistic infection or death among 1173 patients initiating HAART. Durable virologic suppression was defined as having more undetectable (<400 copies/mL) than detectable virus loads after the initiation of therapy. The median durations of therapy and follow-up were 29 and 36 months, respectively. Among patients who achieved durable virologic suppression, those with baseline CD4(+) lymphocyte counts of <200 cells/mm(3) tended to progress faster than those with baseline CD4(+) lymphocyte counts of 201-350 cells/mm(3) (P=.09) and progressed faster than those with baseline CD4(+) lymphocyte counts of >350 cells/mm(3) (P=.01). Among those with durable virologic suppression, there was no difference in disease progression between those with baseline CD4(+) lymphocyte counts of 201-350 cells/mm(3) and those with durable virologic suppression with baseline CD4(+) lymphocyte counts of >350 celld/mm(3) (P=.40). Initiating HAART with a CD4(+) lymphoctye count of <200 cells/mm(3) was associated with a higher risk of disease progression, even with durable virologic suppression. HAART should be initiated at CD4(+) lymphocyte counts of >200 cells/mm(3).
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页码:1659 / 1665
页数:7
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