HIV treatment response and prognosis in Europe and North America in the first decade of highly active antiretroviral therapy: a collaborative analysis

May, Margaret; Sterne, Jonathan A C; Costagliola, Dominique; Sabin, Caroline; An, Peng; Ac, Justice; Dabis, François; Gill, John; Lundgren, Jens D.; Rs, Hogg; F, de Wolf; Fätkenheuer, Gerd; Staszewski, Schlomo; A, d'Arminio Monforte; Egger, Matthias

doi:10.1016/s0140-6736(06)69152-6

Cited by 198 publications

(45 citation statements)

References 33 publications

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“…This suggests that level of response by era may be influenced by factors other than initiation stage related to era for example, although investigation of these potential causal factors is beyond the scope of this study. The observed trends in baseline CD4 cell count and CD4 cell count response are consistent with findings from similarly resourced countries although baseline levels in this study are generally higher than elsewhere (19). Generally, while there is indication of improved later era CD4 cell count response, we found that CD4 cell count measures alone are likely to be insufficient surrogates to differentiate HIV treatment outcomes.…”

Section: Discussionsupporting

confidence: 89%

“…At early stages (less than 4 years after treatment initiation), response is most strongly influenced by pre-initiation conditions and baseline disease stage as well as by the potency of implemented ART, and is also predictive of later outcomes (14–17). Generally, significant levels of virological control are reached within a year of treatment (7, 8, 18, 19). Phillips et al have shown attainment of at least one viral load measure less than 500 copies/ml in 85% of patients within 32 weeks after initiating therapy for early cART era patients, but that there were subsequently increasing rates of viral rebound over the duration of that study (up to 192 weeks) (7).…”

Section: Introductionmentioning

confidence: 99%

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Recent Trends in Early Stage Response to Combination Antiretroviral Therapy in Australia

et al. 2014

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Background There have been improvements in combination antiretroviral therapy (cART) over the last 15 years. The aim of this analysis was to assess whether improvements in ART have resulted in improvements in surrogates of HIV outcome. Methods Patients in the Australian HIV Observational Database who initiated treatment using mono/duo therapy prior to 1996, or using cART from 1996 onwards, were included in the analysis. Patients were stratified by era of ART initiation. Median changes in CD4+ and the proportion of patients with detectable HIV viral load (>400 copies/ml) were calculated over the first 4 years of treatment. Probabilities of treatment switch were estimated using the Kaplan-Meier method. Results 2,753 patients were included in the analysis: 28% initiated treatment <1996 using mono/duo therapy; and 72% initiated treatment ≥1996 using cART (30% 1996–99; 12% 2000–03; 11% 2004–07; and 19% ≥2008). Overall CD4 response improved by later era of initiation (p<0.001), although 2000–03 CD4 response was less than that for 1996–99 (p=0.007). The average proportion with detectable viral load from 2 to 4 years post treatment commencement by era was: <1996 mono/duo 0.69 (0.67–0.71); 1996–99 cART 0.29 (0.28–0.30); 2000–03 cART 0.22 (0.20–0.24); 2004–07 cART 0.09 (0.07–0.10); ≥2008 cART 0.04 (0.03–0.05). Probability of treatment switch at 4 years after initiation decreased from 53% in 1996–99 to 29% after 2008 (p<0.001). Conclusions Across the five time-periods examined, there have been incremental improvements for patients initiated on cART, as measured by overall response (viral load and CD4 count), and also increased durability of first-line ART regimens.

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Recent Trends in Early Stage Response to Combination Antiretroviral Therapy in Australia

et al. 2014

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“…However, there was no corresponding decrease in the rates of AIDS, or death, up to 1 year of follow-up. Conversely, there was some evidence for an increase in the rate of AIDS in the most recent period [2002–2003] [(49), p. 454 – emphasis mine].…”

Section: Hiv-causes-aids: How Valid Are the Data?mentioning

confidence: 99%

RETRACTED: Questioning the HIV-AIDS Hypothesis: 30 Years of Dissent

Goodson

2014

Front. Public Health

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“…Optimal adherence to ART has been shown to be strongly associated with virological suppression of plasma HIV-1 RNA viral load (pVL) and restoration of immunologic function (Cescan et al, 2011; May et al, 2006). However, despite these advances in HIV treatment, people who use illicit drugs (PWID) have frequently been found to exhibit sub-optimal adherence to ART and HIV/AIDS-related morbidity and mortality remains high in this population (Malta et al, 2008; Zwahlen et al, 2009; Larsen et al, 2010).…”

Section: Introductionmentioning

confidence: 99%

High-Intensity Cannabis Use and Adherence to Antiretroviral Therapy Among People Who Use Illicit Drugs in a Canadian Setting

et al. 2014

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Background Cannabis is increasingly prescribed clinically and utilized by people living with HIV/AIDS (PLWHA) to address symptoms of HIV disease and to manage side effects of antiretroviral therapy (ART). In light of concerns about the possibly deleterious effect of psychoactive drug use on adherence to ART, we sought to determine the relationship between high-intensity cannabis use and adherence to ART among a community-recruited cohort of HIV-positive illicit drug users. Methods We used data from the ACCESS study, an ongoing prospective cohort study of HIV-seropositive illicit drug users linked to comprehensive ART dispensation records in a setting of universal no-cost HIV care. We estimated the relationship between at least daily cannabis use in the last six months, measured longitudinally, and the likelihood of optimal adherence to ART during the same period, using a multivariate linear mixed-effects model accounting for relevant socio-demographic, behavioral, clinical and structural factors. Results From May 2005 to May 2012, 523 HIV-positive illicit drug users were recruited and contributed 2430 interviews. At baseline, 121 (23.1%) participants reported at least daily cannabis use. In bivariate and multivariate analyses we did not observe an association between using cannabis at least daily and optimal adherence to prescribed HAART (Adjusted Odds Ratio = 1.12, 95% Confidence Interval [95% CI]: 0.76 – 1.64, p-value = 0.555.) Conclusions High-intensity cannabis use was not associated with adherence to ART. These findings suggest cannabis may be utilized by PLWHA for medicinal and recreational purposes without compromising effective adherence to ART.

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HIV treatment response and prognosis in Europe and North America in the first decade of highly active antiretroviral therapy: a collaborative analysis

Cited by 198 publications

References 33 publications

Recent Trends in Early Stage Response to Combination Antiretroviral Therapy in Australia

Recent Trends in Early Stage Response to Combination Antiretroviral Therapy in Australia

RETRACTED: Questioning the HIV-AIDS Hypothesis: 30 Years of Dissent

High-Intensity Cannabis Use and Adherence to Antiretroviral Therapy Among People Who Use Illicit Drugs in a Canadian Setting

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