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Mortality in HIV-seropositive versus -seronegative persons in the era of highly active antiretroviral therapy: implications for when to initiate therapy.
J Infect Dis. 2004 Sep 15; 190(6):1046-54.JI

Abstract

BACKGROUND

The optimal time to initiate highly active antiretroviral therapy (HAART) remains unclear.

METHODS

Five hundred eighty-three human immunodeficiency virus (HIV)-seropositive and 920 HIV-seronegative injection drug users (IDUs) were followed from 1997 to 2000. HIV-seropositive participants were categorized according to receipt of HAART (either initiated or switched to HAART) and initial CD4 cell count. Survival analysis that included delayed-entry and Cox proportional-hazards models was used to evaluate the effect of HAART, with adjustments for factors associated with access to HAART.

RESULTS

Compared with HIV-seronegative participants, overall survival was similar in HIV-seropositive participants who received HAART at >350 CD4 cells/microL, but mortality was higher both in participants with >350 CD4 cells/microL who did not receive HAART and in participants who received HAART at 200-350 CD4 cells/microL (mortality rates, 19.9, 24.0, 43.0, and 50.5/1000 person-years, respectively). In proportional-hazards models in which HIV-seronegative participants were the reference group and in which age, sex, race, frequency of drug use, substance-abuse treatment, and health-care utilization were adjusted for, hazard ratios were 1.01 (95% confidence interval [CI], 0.41-2.45), 2.28 (95% CI, 1.38-3.78), and 2.09 (95% CI, 1.07-4.10) for the latter 3 groups. In HIV-seropositive participants, HAART significantly improved survival when initiated at CD4 cell counts < 200 cells/microL.

CONCLUSIONS

Survival of HIV-seropositive participants receiving HAART approximated that of HIV-seronegative participants only when therapy was given at CD4 cell counts > 350 cells/microL. These data, restricted to IDUs, suggest initiating or switching to HAART at higher CD4 cell levels than are currently recommended.

Authors+Show Affiliations

Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

15319852

Citation

Wang, Cunlin, et al. "Mortality in HIV-seropositive Versus -seronegative Persons in the Era of Highly Active Antiretroviral Therapy: Implications for when to Initiate Therapy." The Journal of Infectious Diseases, vol. 190, no. 6, 2004, pp. 1046-54.
Wang C, Vlahov D, Galai N, et al. Mortality in HIV-seropositive versus -seronegative persons in the era of highly active antiretroviral therapy: implications for when to initiate therapy. J Infect Dis. 2004;190(6):1046-54.
Wang, C., Vlahov, D., Galai, N., Bareta, J., Strathdee, S. A., Nelson, K. E., & Sterling, T. R. (2004). Mortality in HIV-seropositive versus -seronegative persons in the era of highly active antiretroviral therapy: implications for when to initiate therapy. The Journal of Infectious Diseases, 190(6), 1046-54.
Wang C, et al. Mortality in HIV-seropositive Versus -seronegative Persons in the Era of Highly Active Antiretroviral Therapy: Implications for when to Initiate Therapy. J Infect Dis. 2004 Sep 15;190(6):1046-54. PubMed PMID: 15319852.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Mortality in HIV-seropositive versus -seronegative persons in the era of highly active antiretroviral therapy: implications for when to initiate therapy. AU - Wang,Cunlin, AU - Vlahov,David, AU - Galai,Noya, AU - Bareta,Joseph, AU - Strathdee,Steffanie A, AU - Nelson,Kenrad E, AU - Sterling,Timothy R, Y1 - 2004/08/17/ PY - 2003/12/15/received PY - 2004/03/15/accepted PY - 2004/8/21/pubmed PY - 2004/10/8/medline PY - 2004/8/21/entrez SP - 1046 EP - 54 JF - The Journal of infectious diseases JO - J Infect Dis VL - 190 IS - 6 N2 - BACKGROUND: The optimal time to initiate highly active antiretroviral therapy (HAART) remains unclear. METHODS: Five hundred eighty-three human immunodeficiency virus (HIV)-seropositive and 920 HIV-seronegative injection drug users (IDUs) were followed from 1997 to 2000. HIV-seropositive participants were categorized according to receipt of HAART (either initiated or switched to HAART) and initial CD4 cell count. Survival analysis that included delayed-entry and Cox proportional-hazards models was used to evaluate the effect of HAART, with adjustments for factors associated with access to HAART. RESULTS: Compared with HIV-seronegative participants, overall survival was similar in HIV-seropositive participants who received HAART at >350 CD4 cells/microL, but mortality was higher both in participants with >350 CD4 cells/microL who did not receive HAART and in participants who received HAART at 200-350 CD4 cells/microL (mortality rates, 19.9, 24.0, 43.0, and 50.5/1000 person-years, respectively). In proportional-hazards models in which HIV-seronegative participants were the reference group and in which age, sex, race, frequency of drug use, substance-abuse treatment, and health-care utilization were adjusted for, hazard ratios were 1.01 (95% confidence interval [CI], 0.41-2.45), 2.28 (95% CI, 1.38-3.78), and 2.09 (95% CI, 1.07-4.10) for the latter 3 groups. In HIV-seropositive participants, HAART significantly improved survival when initiated at CD4 cell counts < 200 cells/microL. CONCLUSIONS: Survival of HIV-seropositive participants receiving HAART approximated that of HIV-seronegative participants only when therapy was given at CD4 cell counts > 350 cells/microL. These data, restricted to IDUs, suggest initiating or switching to HAART at higher CD4 cell levels than are currently recommended. SN - 0022-1899 UR - https://www.unboundmedicine.com/medline/citation/15319852/Mortality_in_HIV_seropositive_versus__seronegative_persons_in_the_era_of_highly_active_antiretroviral_therapy:_implications_for_when_to_initiate_therapy_ L2 - https://academic.oup.com/jid/article-lookup/doi/10.1086/422848 DB - PRIME DP - Unbound Medicine ER -