Timing of HAART initiation and clinical outcomes in human immunodeficiency virus type 1 seroconverters.
Timing of HAART initiation and clinical outcomes in human immunodeficiency virus type 1 seroconverters.
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HAART启动和人类免疫缺陷病毒1型血清抗体的时机。
DOI：
10.1001/archinternmed.2011.401
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发表时间：
2011-09-26
影响因子：
--
通讯作者：
Eron, Joseph J., Jr.
中科院分区：
文献类型：
--
作者：
Funk, Michele Jonsson;Fusco, Jennifer S.;Cole, Stephen R.;Thomas, James C.;Porter, Kholoud;Kaufman, Jay S.;Davidian, Marie;White, Alice D.;Hartmann, Katherine E.;Eron, Joseph J., Jr.
在CD 4计数<800个细胞/µL的患者中，评估在给定月份开始HAART治疗与延迟治疗的临床获益。在这项CASCADE HIV-1血清转换者的观察性队列研究中，我们构建了从1996年1月至2009年5月的每月连续嵌套亚队列，包括所有符合条件的HAART初治、无艾滋病且CD 4计数<800个细胞/uL的个体。主要结局是在基线月开始HAART的患者与未开始HAART的患者相比，至AIDS或死亡的时间，汇总各亚组并按CD 4分层。使用逆概率治疗加权生存曲线和考克斯比例风险模型，我们估计了治疗的绝对和相对效果，具有稳健的95%置信区间（括号内）。在9，455例患者中，52，268人年随访，812人（8.6%）发展为艾滋病，544人（5.8%）死亡。在200-349、350-499和500-799个细胞/微升的CD 4分层中，HAART启动与AIDS/死亡的校正风险比相关，为0.59（0.43，0.81），0.75（0.49，1.14）和1.10（0.67，1.79）;调整后的3年累积风险差异分别为-4.8%（-7.0%，-2.6%）、-2.9%（-5.0%，-0.9%）和0.3%（-3.7%，4.2%）。在全因死亡率分析中，HAART启动与校正后的风险比分别为0.71（0.44，1.15）、0.51（0.33，0.80）和1.02（0.49，2.12）。在CD 4 200-349和350-499个细胞/微升的分层中，3年内预防一次AIDS事件或死亡所需的治疗人数分别为21（14，38）和34（20，115）。与在给定月份推迟相比，在CD 4计数<500（但不是500-799）个细胞/微升时开始HAART与疾病进展较慢相关。
To estimate the clinical benefit of HAART initiation versus deferral in a given month among patients with CD4 counts <800 cells/µL. In this observational cohort study of HIV-1 seroconverters from CASCADE, we constructed monthly sequential nested subcohorts from 1/1996 to 5/2009 including all eligible HAART-naïve, AIDS-free individuals with a CD4 count <800 cells/uL. The primary outcome was time to AIDS or death among those who initiated HAART in the baseline month compared to those who did not, pooled across subcohorts and stratified by CD4. Using inverse-probability-of-treatment-weighted survival curves and Cox proportional hazards models, we estimated the absolute and relative effect of treatment with robust 95% confidence intervals (in parentheses). Of 9,455 patients with 52,268 person-years of follow-up, 812 (8.6%) developed AIDS and 544 (5.8%) died. Within CD4 strata of 200–349, 350–499, and 500–799 cells/µL, HAART initiation was associated with adjusted hazard ratios for AIDS/death of 0.59 (0.43,0.81), 0.75 (0.49,1.14), and 1.10 (0.67,1.79), respectively; and with adjusted 3-year cumulative risk differences of −4.8% (−7.0%,−2.6%), −2.9% (−5.0%,−0.9%), and 0.3% (−3.7%,4.2%), respectively. In the analysis of all-cause mortality, HAART initiation was associated with adjusted hazard ratios of 0.71 (0.44,1.15), 0.51 (0.33,0.80) and 1.02 (0.49,2.12), respectively. Numbers needed to treat to prevent one AIDS event or death within 3 years were 21 (14,38) and 34 (20,115) in CD4 strata of 200–349 and 350–499 cells/µL, respectively. Compared to deferring in a given month, HAART initiation at CD4 counts <500 (but not 500–799) cells/µL was associated with slower disease progression.
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影响因子：
168.9
作者：
Cameron, DW;Heath-Chiozzi, M;Leonard, J
通讯作者：
Leonard, J
影响因子：
5
作者：
Cole, Stephen R.;Hernan, Miguel A.
通讯作者：
Hernan, Miguel A.
影响因子：
168.9
作者：
Porter, K;Babiker, AG;Walker, AS
通讯作者：
Walker, AS
影响因子：
4.1
作者：
Sabin, Caroline A.
通讯作者：
Sabin, Caroline A.
DOI：
10.1056/nejmoa0807252
发表时间：
2009-04-30
期刊：
The New England journal of medicine
影响因子：
--
作者：
Kitahata MM;Gange SJ;Abraham AG;Merriman B;Saag MS;Justice AC;Hogg RS;Deeks SG;Eron JJ;Brooks JT;Rourke SB;Gill MJ;Bosch RJ;Martin JN;Klein MB;Jacobson LP;Rodriguez B;Sterling TR;Kirk GD;Napravnik S;Rachlis AR;Calzavara LM;Horberg MA;Silverberg MJ;Gebo KA;Goedert JJ;Benson CA;Collier AC;Van Rompaey SE;Crane HM;McKaig RG;Lau B;Freeman AM;Moore RD;NA-ACCORD Investigators
通讯作者：
NA-ACCORD Investigators