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When to begin highly active antiretroviral therapy? Evidence supporting initiation of therapy at CD4+ lymphocyte counts <350 cells/microL.
Clin Infect Dis. 2003 Oct 01; 37(7):951-8.CI

Abstract

We assessed the risk of acquired immunodeficiency syndrome (AIDS)-related opportunistic illness or death among persons first prescribed highly active antiretroviral therapy (HAART) in January 1996 or later in the Centers for Disease Control and Prevention's Adult and Adolescent HIV Spectrum of Disease Project. Patients were included if they were naive to antiretroviral drugs and had no history of AIDS-related opportunistic illness. Risk was assessed as a function of CD4+ lymphocyte count and human immunodeficiency virus load at the time of initiation of HAART in a Cox proportional hazards model. Hazard ratios for AIDS or death were 6.3, 3.5, and 1.7 for persons with baseline CD4+ cell counts of 0-49, 50-199, and 200-349 cells/microL, respectively, compared with the referent (CD4+ cell count > or =500 cells/microL). HAART should not be deferred until the CD4+ cell count reaches <200 cells/microL. The increased hazard associated with CD4+ cell counts of 200-349 cells/microL was modest but supports initiation of HAART at CD4+ cell counts <350 cells/microL, particularly in patients with high virus loads.

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Authors+Show Affiliations

Kaplan JE
Surveillance and Epidemiology, Division of HIV/AIDS Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. jxk2@cdc.gov
Hanson DL
No affiliation info available
Cohn DL
No affiliation info available
Karon J
No affiliation info available
Buskin S
No affiliation info available
Thompson M
No affiliation info available
Fleming P
No affiliation info available
Dworkin MS
No affiliation info available
Adult and Adolescent Spectrum of HIV Disease Project Investigators
No affiliation info available

MeSH

AdolescentAdultAnti-HIV AgentsAntiretroviral Therapy, Highly ActiveCD4 Lymphocyte CountFemaleHIV InfectionsHIV-1HumansMaleSurvival AnalysisTime FactorsViral Load

Pub Type(s)

Journal Article

Language

eng

PubMed ID

13130408

Citation

Kaplan, Jonathan E., et al. "When to Begin Highly Active Antiretroviral Therapy? Evidence Supporting Initiation of Therapy at CD4+ Lymphocyte Counts <350 Cells/microL." Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, vol. 37, no. 7, 2003, pp. 951-8.
Kaplan JE, Hanson DL, Cohn DL, et al. When to begin highly active antiretroviral therapy? Evidence supporting initiation of therapy at CD4+ lymphocyte counts <350 cells/microL. Clin Infect Dis. 2003;37(7):951-8.
Kaplan, J. E., Hanson, D. L., Cohn, D. L., Karon, J., Buskin, S., Thompson, M., Fleming, P., & Dworkin, M. S. (2003). When to begin highly active antiretroviral therapy? Evidence supporting initiation of therapy at CD4+ lymphocyte counts <350 cells/microL. Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, 37(7), 951-8.
Kaplan JE, et al. When to Begin Highly Active Antiretroviral Therapy? Evidence Supporting Initiation of Therapy at CD4+ Lymphocyte Counts <350 Cells/microL. Clin Infect Dis. 2003 Oct 1;37(7):951-8. PubMed PMID: 13130408.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - When to begin highly active antiretroviral therapy? Evidence supporting initiation of therapy at CD4+ lymphocyte counts <350 cells/microL. AU - Kaplan,Jonathan E, AU - Hanson,Debra L, AU - Cohn,David L, AU - Karon,John, AU - Buskin,Susan, AU - Thompson,Melanie, AU - Fleming,Patricia, AU - Dworkin,Mark S, AU - ,, Y1 - 2003/09/12/ PY - 2003/02/26/received PY - 2003/05/31/accepted PY - 2003/9/18/pubmed PY - 2003/11/5/medline PY - 2003/9/18/entrez SP - 951 EP - 8 JF - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America JO - Clin Infect Dis VL - 37 IS - 7 N2 - We assessed the risk of acquired immunodeficiency syndrome (AIDS)-related opportunistic illness or death among persons first prescribed highly active antiretroviral therapy (HAART) in January 1996 or later in the Centers for Disease Control and Prevention's Adult and Adolescent HIV Spectrum of Disease Project. Patients were included if they were naive to antiretroviral drugs and had no history of AIDS-related opportunistic illness. Risk was assessed as a function of CD4+ lymphocyte count and human immunodeficiency virus load at the time of initiation of HAART in a Cox proportional hazards model. Hazard ratios for AIDS or death were 6.3, 3.5, and 1.7 for persons with baseline CD4+ cell counts of 0-49, 50-199, and 200-349 cells/microL, respectively, compared with the referent (CD4+ cell count > or =500 cells/microL). HAART should not be deferred until the CD4+ cell count reaches <200 cells/microL. The increased hazard associated with CD4+ cell counts of 200-349 cells/microL was modest but supports initiation of HAART at CD4+ cell counts <350 cells/microL, particularly in patients with high virus loads. SN - 1537-6591 UR - https://www.unboundmedicine.com/medline/citation/13130408/When_to_begin_highly_active_antiretroviral_therapy_Evidence_supporting_initiation_of_therapy_at_CD4+_lymphocyte_counts_<350_cells/microL_ L2 - https://academic.oup.com/cid/article-lookup/doi/10.1086/377606 DB - PRIME DP - Unbound Medicine ER -
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