Initiation of antiretroviral therapy at high CD4 cell counts

Longenecker, Chris T.; Triant, Virginia A.

doi:10.1097/coh.0000000000000015

Cited by 28 publications

(18 citation statements)

References 102 publications

(130 reference statements)

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“…This includes liver diseases [26], non-AIDS malignancies [27, 28] and renal diseases [29]. Whereas, other diseases, particularly cardio-cerebrovascular diseases do not seem to follow this pattern [30]. …”

Section: Discussionmentioning

confidence: 99%

The burden of chronic diseases and cost-of-care in subjects with HIV infection in a Health District of Northern Italy over a 12-year period compared to that of the general population

Quiros-Roldan

Magoni²,

Raffetti

et al. 2016

BMC Public Health

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BackgroundThe increase in life expectancy of HIV-infected patients has driven increased costs due to life-long HIV treatment and concurrent age-related comorbidities. This population-based study aimed to investigate the burden of chronic diseases and health costs for HIV+ subjects compared to the general population living in Brescia Local health Agency (LHA) over a 12-year period.MethodsLHA database recorded diagnoses, deaths, drug prescriptions and health resource utilization for all residents during 2003–2014. We estimated HIV prevalence and incidence, HIV-related mortality as well as prevalence of chronic diseases in HIV+ subjects. Observed/expected ratio of chronic diseases was calculated by indirect standardization with the general population as reference. Direct cost of HIV care and determinants were estimates across the period.ResultsHIV prevalence increased from 220 to 307 per 100 000 person-years while incidence decreased from 16.1 to 10.8 per 100 000 person-years from 2003 to 2014. Prevalence of most comorbidities increased over time but it reduced significantly (annual mean change − 0.7 %) when adjusting for age and gender. Observed to expected ratio for each chronic disease in HIV+ subjects decreased over time. Cost of HIV+ cures increased (+25 %) mainly due to cost for drugs (+50 %) but it stabilized in recent years. CD4+ cell count at the time of diagnosis was an important predictor of cost for HIV management.ConclusionsExpenditures for HIV-infection are driven mainly by drugs cost and they have increased overtime. However, our findings suggest that spending on public health for HIV care can improve prognosis of HIV-infected patients, reduce transmission of HIV infection and reduce the global burden of chronic diseases, leading to a reduction of HIV global cost in the medium-long time.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3804-4) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

The burden of chronic diseases and cost-of-care in subjects with HIV infection in a Health District of Northern Italy over a 12-year period compared to that of the general population

Quiros-Roldan

Magoni²,

Raffetti

et al. 2016

BMC Public Health

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“…Early epidemiologic studies associated ARVs, particularly PIs, with an increased risk of MI [37]; however, modern cART regimens exhibit less toxicity relative to their predecessors. Despite their improvement, cART medications themselves may still have an impact on CVD risk, although the current consensus is that ART has a net cardiovascular benefit [38]. …”

Section: Cardiac Function and Cardiovascular Disease Riskmentioning

confidence: 99%

Complications of Treatment in Youth with HIV

et al. 2016

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While combination antiretroviral therapy allows HIV-infected patients to have life expectancies similar to that of the general population, it may also contribute to the development of co-morbidities, such as cardiovascular disease and osteoporosis. Such complications could compromise long-term quality of life, especially in HIV-infected youth whose lifetime cumulative exposure to antiretrovirals is likely to be many decades. Recent studies continue to demonstrate abnormalities associated with antiretroviral therapy, although clinical manifestations are rare in this younger population, especially with modern antiretrovirals. The purpose of this paper is to review the most recent literature on complications of treatment in youth with HIV.

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“…In the nearly two decades since, we have developed a greater understanding of the epidemiology and mechanisms of cardiovascular disease (CVD) among those with HIV infection. Recent reviews in this journal have summarized this evolving field in terms of the epidemiology and risk factors for CVD in HIV[2] and whether early ART might reduce CVD risk[3]. …”

Section: Introductionmentioning

confidence: 99%

Immune activation and cardiovascular disease in chronic HIV infection

Longenecker

Sullivan

Baker³

2016

Current Opinion in HIV and AIDS

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Purpose of review To describe the potential contribution of immune activation in the pathogenesis of HIV-associated cardiovascular disease (CVD)—a leading cause of morbidity and mortality among HIV positive persons with access to antiretroviral therapy (ART). Recent findings We review recent literature that suggests abnormalities in both adaptive and innate immunity contributes to CVD risk among persons with HIV infection. In particular, potentially atherogenic T-cell mechanisms include persistent high-level T-cell activation (and associated pro-inflammatory mechanisms), as well as the presence of co-pathogens (e.g., CMV) providing an ongoing stimulus for cytotoxic T-cell responses. More recent data has then emphasized the potential impact of monocyte/macrophage-mediated inflammation and injury within atherosclerotic lesions. The pathology driving innate immune activation many not fully reverse with ART treatment, highlighting the need for interventions that target inflammation as a CVD prevention strategy. Summary Premature CVD among persons with HIV infection is due, in part, to persistent abnormalities in immune activation and systemic inflammation despite viral suppression. Prevention strategies for persons with HIV infection include those that target traditional CVD risk factors as well as newer candidate treatments with potential immunomodulatory benefits.

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Initiation of antiretroviral therapy at high CD4 cell counts

Cited by 28 publications

References 102 publications

The burden of chronic diseases and cost-of-care in subjects with HIV infection in a Health District of Northern Italy over a 12-year period compared to that of the general population

The burden of chronic diseases and cost-of-care in subjects with HIV infection in a Health District of Northern Italy over a 12-year period compared to that of the general population

Complications of Treatment in Youth with HIV

Immune activation and cardiovascular disease in chronic HIV infection

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