Clinical efficacy of early initiation of HAART in patients with asymptomatic HIV infection and CD4 cell count &gt; 350 × 106/l

Opravil, Milos; Ledergerber, Bruno; Furrer, Hansjakob; Hirschel, Bernard; Imhof, Alexander; Gallant, Serge; Wagels, Thomas; Bernasconi, Enos; Meienberg, Fabian; Rickenbach, Martin; Weber, Rainer

doi:10.1097/00002030-200207050-00009

Cited by 109 publications

(48 citation statements)

References 44 publications

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“…Opravil et al [27] reported that individuals who initiated ART with !350 CD4 T cells/mL experienced significantly more CDC category B or C events than did patients who initiated ART with higher CD4 T cell counts. In the present study, 22 (21.0%) of 105 incomplete responders had clinical CDC category B or C events; for 15 (68%), the events were opportunistic infections.…”

Section: Discussionmentioning

confidence: 99%

Characteristics, Determinants, and Clinical Relevance of CD4 T Cell Recovery to <500 Cells/ L in HIV Type 1--Infected Individuals Receiving Potent Antiretroviral Therapy

Kaufmann

Furrer

Ledergerber

et al. 2005

Clinical Infectious Diseases

290

270

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Background. The CD4 T cell count recovery in human immunodeficiency virus type 1 (HIV-1)-infected individuals receiving potent antiretroviral therapy (ART) shows high variability. We studied the determinants and the clinical relevance of incomplete CD4 T cell restoration.Methods. Longitudinal CD4 T cell count was analyzed in 293 participants of the Swiss HIV Cohort Study who had had a plasma HIV-1 RNA load !1000 copies/mL for у5 years. CD4 T cell recovery was stratified by CD4 T cell count 5 years after initiation of ART (у500 cells/mL was defined as a complete response, and !500 cells/mL was defined as an incomplete response). Determinants of incomplete responses and clinical events were evaluated using logistic regression and survival analyses.Results. The median CD4 T cell count increased from 180 cells/mL at baseline to 576 cells/mL 5 years after ART initiation. A total of 35.8% of patients were incomplete responders, of whom 47.6% reached a CD4 T cell plateau !500 cells/mL. Centers for Disease Control and Prevention HIV-1 disease category B and/or C events occurred in 21% of incomplete responders and in 14.4% of complete responders ( ). Older age (adjusted P 1 .05 odds ratio [aOR], 1.71 per 10-year increase; 95% confidence interval [CI], 1.21-2.43), lower baseline CD4 T cell count (aOR, 0.37 per 100-cell increase; 95% CI, 0.28-0.49), and longer duration of HIV infection (aOR, 2.39 per 10-year increase; 95% CI, 1.19-4.81) were significantly associated with a CD4 T cell count !500 cells/mL at 5 years. The median increases in CD4 T cell count after 3-6 months of ART were smaller in incomplete responders ( ) and predicted, in conjunction with baseline CD4 T cell count and age, incomplete response with 80% P ! .001 sensitivity and 72% specificity.Conclusion. Individuals with incomplete CD4 T cell recovery to !500 cells/mL had more advanced HIV-1 infection at baseline. CD4 T cell changes during the first 3-6 months of ART already reflect the capacity of the immune system to replenish depleted CD4 T lymphocytes.

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Section: Discussionmentioning

confidence: 99%

Characteristics, Determinants, and Clinical Relevance of CD4 T Cell Recovery to <500 Cells/ L in HIV Type 1--Infected Individuals Receiving Potent Antiretroviral Therapy

Kaufmann

Furrer

Ledergerber

et al. 2005

Clinical Infectious Diseases

290

270

View full text Add to dashboard Cite

show abstract

“…Increasing evidence suggests a reduction in death, opportunistic infections, and serious non-AIDS events and an increase in rates of maximal virologic suppression and CD4 cell counts in patients who initiate therapy with CD4 counts between 200 to 350 cells/l (5,10,16,20,29,30,38,43,49,53,57,67). Data from a large observational cohort recently demonstrated an increased risk of death in patients who did not initiate antiretroviral therapy with CD4 counts either between 351 to 500 cells/l or of Ͼ500 cells/l relative to patients in those CD4 strata that did initiate therapy (26).…”

Section: When To Start Therapy?mentioning

confidence: 99%

Antiretroviral Therapy in the Clinic

Tsibris

Hirsch

2010

J Virol

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Currently, over 25 antiretroviral drugs and several fixed-dose drug combinations are available in most developed countries. Individual agents target many of the critical steps in the HIV replication cycle-entry, reverse transcription, integration, and proteolytic processing. Newer regimens offer greater convenience and less toxicity than ones previously used, and emerging data suggest that antiretroviral therapy should be initiated earlier during the natural history of HIV infection than was previously recommended (54). Randomized comparative testing has demonstrated superior clinical, immunologic, and virologic outcomes with certain drug combinations, although the use of certain otherwise effective antiretroviral regimens may sometimes be limited by co-morbid illnesses and toxicities. This review focuses on the translation of insights gleaned from both bench and clinical research into the day-to-day care of HIV-infected patients. We discuss the practical issues of how to choose an antiretroviral regimen, when to start therapy, how to monitor the clinical response, and how to adjust therapy for treatment failure or drug-associated toxicities.

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“…There is consensus that therapy should be initiated when a patient develops an opportunistic infection or has CD4 cell count < 200 [23]. Above this, there is a debate over the optimal starting CD4 cell count [24][25][26]. Data indicates a much higher morbidity and mortality rate if started at CD4 < 200.…”

Section: Key Principles and Complexities Of Antiretroviral Therapymentioning

confidence: 99%

Approaches to antiretroviral therapy in China

Gilliam

Redfield

2005

Cell Res

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China has recognized the threat of HIV to its population and responded with a national antiretroviral treatment (ART) program. However, high ART failure rates and the spread of resistance within populations are important realities to consider when developing and managing ART programs in China and worldwide. Concepts which will define treatment success and local and national programmatic goals are 1) access to ART, 2) durability of ART at the patient level, 3) scalability of treatment modalities, and the 4) sustainability of the program at the community or national level. In the face of limited resources, China must also consider when to start ARV therapy, which agents to use, when to switch them, and how to treat highly experienced patients with drug resistance. The optimal ARV regimen to start with is changing frequently with the introduction of new agents and the presentation of new data. Currently, a regimen including tenofovir, emtricitabine or lamivudine and a nonnucleoside reverse transcriptase inhibitor appears to have optimal characteristics to treat HIV/AIDS in China. However, critical to all of these choices is the evaluation of programs implemented to insure wide scale success. China has wisely begun this process of evaluating the performance of local programs through systematic monitoring and evaluation of treatment outcomes. This will allow regimens and programs that work to be expanded, and programs with high failure rates to be eliminated. In the end, evidence based data supporting treatment strategies will allow China to successfully confront its AIDS epidemic early and prevent its tragic consequences

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Clinical efficacy of early initiation of HAART in patients with asymptomatic HIV infection and CD4 cell count > 350 × 106/l

Abstract: 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.

Cited by 109 publications

References 44 publications

Characteristics, Determinants, and Clinical Relevance of CD4 T Cell Recovery to <500 Cells/ L in HIV Type 1--Infected Individuals Receiving Potent Antiretroviral Therapy

Characteristics, Determinants, and Clinical Relevance of CD4 T Cell Recovery to <500 Cells/ L in HIV Type 1--Infected Individuals Receiving Potent Antiretroviral Therapy

Antiretroviral Therapy in the Clinic

Approaches to antiretroviral therapy in China

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