Benchmarks for antiretroviral therapy

Cohen, Oren J.; Fauci, Anthony S.

doi:10.1172/jci9590

Cited by 8 publications

(4 citation statements)

References 26 publications

(25 reference statements)

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“…Furthermore, our subanalysis exploring whether baseline viral load remains an important predictor of suppression later in follow‐up indicates that, after 18 months of therapy, baseline viral load is no longer significantly associated with suppression. This finding supports those of past studies in which it was concluded that time to suppression is a mathematical function corresponding to baseline viral load [28,29].…”

Section: Discussionsupporting

confidence: 91%

“…However, our work demonstrates that baseline viral load is a more important predictor of time to virological suppression, which supports findings from past studies [28][29][30]. Furthermore, our subanalysis exploring whether baseline viral load remains an important predictor of suppression later in follow-up indicates that, after 18 months of therapy, baseline viral load is no longer significantly associated with suppression.…”

Section: Discussionsupporting

confidence: 88%

“…Furthermore, our subanalysis exploring whether baseline viral load remains an important predictor of suppression later in follow-up indicates that, after 18 months of therapy, baseline viral load is no longer significantly associated with suppression. This finding supports those of past studies in which it was concluded that time to suppression is a mathematical function corresponding to baseline viral load [28,29].In our cohort, women were less likely than men to achieve virological suppression. This is in contrast to other evaluations that have found similar [31,32] or improved [33] virological suppression compared with men.…”

supporting

confidence: 92%

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Factors associated with virological suppression among HIV-positive individuals on highly active antiretroviral therapy in a multi-site Canadian cohort

et al. 2010

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ObjectiveThe aim of the study was to evaluate time to virological suppression in a cohort of individuals who started highly active antiretroviral therapy (HAART), and to explore the factors associated with suppression. MethodsEligible participants were HIV-positive individuals from a multi-site Canadian cohort of antiretroviral-naïve patients initiating HAART on or after 1 January 2000. Viral load and CD4 measurements within 6 months prior to HAART initiation were assessed. Univariate and multivariate analyses were conducted using piecewise survival exponential models where time scale was divided into intervals (o10 months; 10 months). Virological suppression was defined as the time to the first of at least two consecutive viral load measurements o50 HIV-1 RNA copies/mL. ResultsA total of 3555 individuals were included in the study, of median age 40 years [interquartile range (IQR) 34-47 years]. Eighty per cent were male, 18% had a history of injecting drug use (IDU), and 13% presented with an AIDS-defining illness at baseline. The median time to suppression was 4.55 months . In multivariate analyses, older age, male sex, treatment in Ontario rather than British Columbia, non-IDU history, and having an AIDS diagnosis at baseline predicted increased likelihood of suppression. Patients with low baseline viral load were more likely to have suppression [4-5 log 10 copies/mL, hazard ratio (HR) 1.27, 95% confidence interval (CI) 1.18-1.38; o4 log 10 copies/mL, HR 1.49, 95% CI 1.32-1.68] than patients with baseline viral load 5 log 10 copies/mL; however, this effect ceased after 18 months of follow-up. Suppression was more likely with nonnucleoside reverse transcriptase inhibitors and ritonavir-boosted HAART. ConclusionIdentification of patients at risk for diminished likelihood of virological suppression will allow focusing of efforts and the utilization of resources to maximize the benefits of HAART.Keywords: Canada, CANOC, highly active antiretroviral therapy, HIV, virological suppression Accepted 17 August 2010Correspondence: Dr Curtis Cooper, The Ottawa Hospital Division of Infectious Diseases, University of Ottawa, G12 501 Smyth Rd, Ottawa, ON K1H 8L6, Canada. Tel: 613 737 8924; fax: 613 737 8164; e-mail: ccooper@Ottawahospital.on.ca DOI: 10.1111/j.1468-1293.00890.x HIV Medicine (2011 r 2010 British HIV Association 352 IntroductionIt is well documented that highly active antiretroviral therapy (HAART) decreases morbidity and mortality amongst HIV-positive individuals [1][2][3][4]. In particular, one of the primary goals of HAART is the obtainment and maintenance of complete HIV RNA suppression [5]. Failure to achieve and maintain suppression can result in the development of drug resistance and also increases the risk of both horizontal and vertical viral transmission [6][7][8].When first initiating antiretroviral therapy, the obtainment of viral load suppression is an important objective that is associated with a variety of socio-demographic and baseline clinical factors [9,10]. Additionally, choice of initial...

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 88%

supporting

confidence: 92%

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Factors associated with virological suppression among HIV-positive individuals on highly active antiretroviral therapy in a multi-site Canadian cohort

et al. 2010

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“…Rapid shutdown of T cell activation by cyclosporin A in the early phase of HIV infection proved to be beneficial for both immunological and virological measures by preventing ongoing infection of new target cells in the lymphoid tissue [2,42]. Recent reports have shown that immune reconstitution in the intestinal lymphoid tissues did not take place after antiretroviral therapy in acute and early stage HIV infection [43,44].…”

Section: Discussionmentioning

confidence: 99%

Effect of Antiretroviral Therapy on Apoptosis Markers and Morphology in Peripheral Lymph Nodes of HIV-Infected Individuals

et al. 2008

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Background: CD4+ T cell depletion and destruction and the involution of the lymphoid tissue are hallmarks of HIV infection. Although the underlying mechanisms are still unclear, apoptosis appears to play a central role. The objective of this study was to investigate the effect of antiretroviral therapy on the lymph node tissue, particularly with respect to morphology and apoptosis. Patients and Methods: Between 1997 and 1999, two inguinal lymph nodes were excised from 31 previously untreated individuals who were in an early stage of HIV infection, the first one prior to treatment and the second after 16 to 20 months of treatment. Paraffin sections were investigated for lymph node architecture, distribution of cellular and viral markers, apoptosis, and expression of apoptotic key molecules which indirectly reflect apoptotic processes.

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