Early antiretroviral therapy: the role of cohorts
Early antiretroviral therapy: the role of cohorts
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DOI：
10.1097/coh.0b013e32832c06ad
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发表时间：
2009-05-01
影响因子：
4.1
通讯作者：
Sabin, Caroline A.
中科院分区：
文献类型：
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作者：
Sabin, Caroline A.
综述目的综述有助于对艾滋病毒感染者开始高活性抗逆转录病毒治疗的最佳时间进行辩论的数据，重点关注从队列研究中获得的信息。最近的发现队列研究的结果一般支持在CD4细胞计数超过350细胞/ μ l时开始高活性抗逆转录病毒治疗，特别是在接受治疗的艾滋病毒感染者中死亡率高于一般人群，并且在CD4细胞计数较低的人群中（即使计数保持在350细胞/ μ l以下），艾滋病和严重非艾滋病事件的风险更高。提示早期开始高活性抗逆转录病毒治疗可以预防一些过高的发病率和死亡率。然而，考虑到许多分析缺乏对前置时间偏差的调整，潜在的残留混淆以及可能不完全确定队列中的相关结果，因此不能得出结论，在CD4细胞计数较高时开始高活性抗逆转录病毒治疗的益处将超过可能的有害影响。尽管目前来自队列研究的数据支持在CD4细胞计数超过350细胞/ μ l时开始高活性抗逆转录病毒治疗，但迫切需要来自随机试验的数据来为这一决定提供信息。
Purpose of reviewTo review the data that contribute to the debate on the optimal time to initiate highly active antiretroviral therapy in HIV-infected individuals, with a focus on the information that is available from cohort studies.Recent findingsThe findings from cohort studies generally support initiation of highly active antiretroviral therapy at CD4 cell counts more than 350 cells/mu l. In particular, the findings that death rates among treated HIV-infected individuals are higher than those in the general population, and that the risks of AIDS and serious non-AIDS events are higher in those with lower CD4 cell counts (even when the count remains >350 cells/mu l), suggest that earlier initiation of highly active antiretroviral therapy may prevent some excess morbidity and mortality. However, given the lack of adjustment for lead-time bias in many analyses, the potential for residual confounding and the possible incomplete ascertainment of relevant outcomes in cohorts, it cannot be concluded that the benefits of highly active antiretroviral therapy when started at higher CD4 cell counts will outweigh the possible detrimental effects.SummaryWhereas the data from cohort studies currently support initiation of highly active antiretroviral therapy at CD4 cell counts more than 350 cells/mu l, there is an urgent need for data from randomized trials to inform this decision.