Clinical efficacy of early initiation of HAART in patients with asymptomatic HIV infection and CD4 cell count > 350 x 10(6) /l

Details

Serval ID
serval:BIB_6934D83FE9DC
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Clinical efficacy of early initiation of HAART in patients with asymptomatic HIV infection and CD4 cell count > 350 x 10(6) /l
Journal
AIDS
Author(s)
Opravil  M., Ledergerber  B., Furrer  H., Hirschel  B., Imhof  A., Gallant  S., Wagels  T., Bernasconi  E., Meienberg  F., Rickenbach  M., Weber  R.
ISSN
0269-9370 (Print)
Publication state
Published
Issued date
07/2002
Volume
16
Number
10
Pages
1371-81
Notes
Clinical Trial
Comparative Study
Journal Article
Research Support, Non-U.S. Gov't --- Old month value: Jul 5
Abstract
OBJECTIVE: To evaluate the efficacy of early initiation of highly active antiretroviral therapy (HAART), we compared the clinical course of two nested, matched cohorts within the Swiss HIV Cohort Study. METHODS: We selected all asymptomatic patients who started HAART between 1 January 1996 and 31 December 1999 with a CD4 cell count > 350 x 10(6)/l. We then matched them with asymptomatic participants who were seen at around the same time and who remained untreated during the following 12 months. This control group was further matched for age, sex, CD4 cell count, viral load, and HIV risk category, generating 283 pairs of treated versus untreated patients. RESULTS: During observation of median 3.19 versus 2.66 years, CDC stage B/C occurred in 6.4% versus 21.2%, AIDS in 1.8% versus 5.3%, death in 2.1% versus 6.4%, and AIDS or death of 'natural' causes in 2.8% versus 6.7% of the treated versus untreated patients. In multivariable Cox regression analysis, treatment reduced the risk of clinical progression by a factor of four- to five fold. During follow-up, the treated group had significantly higher CD4 counts and lower HIV-1 RNA levels. Intolerance/adverse events led to change or stop of at least one drug in 35% of treated patients. The entire regimen was interrupted at least once by 41% of patients, and 24% had no treatment anymore at the end of follow-up. CONCLUSIONS: The initiation of HAART in asymptomatic patients with CD4 cell count > 350 x 10(6)/l significantly delayed clinical progression. However, the risk of severe clinical events with deferred therapy was low and must be counter balanced against the burden and toxicity of HAART.
Keywords
Acquired Immunodeficiency Syndrome/drug therapy Anti-HIV Agents/*therapeutic use *Antiretroviral Therapy, Highly Active CD4 Lymphocyte Count Cohort Studies Disease Progression Female HIV Infections/*drug therapy/immunology Humans Male Proportional Hazards Models Treatment Outcome Viral Load
Pubmed
Web of science
Create date
29/01/2008 8:52
Last modification date
20/08/2019 14:24
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