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The effect of combined antiretroviral therapy on the overall mortality of HIV-infected individuals

Ray, M; Logan, R; Sterne, JAC; Hernandez-Diaz, S; Robins, JM; Sabin, C; Bansi, L; ... HIV-CAUSAL Collaboration, ; + view all (2010) The effect of combined antiretroviral therapy on the overall mortality of HIV-infected individuals. AIDS , 24 (1) 123 - 137. 10.1097/QAD.0b013e3283324283.

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Abstract

Objective: To estimate the effect of combined antiretroviral therapy (cART) on mortality among HIV-infected individuals after appropriate adjustment for time-varying confounding by indication.Design: A collaboration of 12 prospective cohort studies from Europe and the United States (the HIV-CAUSAL Collaboration) that includes 62 760 HIV-infected therapy-naive individuals followed for an average of 3.3 years. Inverse probability weighting of marginal structural models was used to adjust for measured Confounding by indication.Results: Two thousand and thirty-nine individuals died during the follow-up. The mortality hazard ratio was 0.48 (95% confidence interval 0.41-0.57) for cART initiation versus no initiation. In analyses stratified by CD4 cell count at baseline, the corresponding hazard ratios were 0.29 (0.22-0.37) for less than 100 cells/mu l, 0.33 (0.25-0.44) for 100 to less than 200 cells/mu l, 0.38 (0.28-0.52) for 200 to less than 350 cells/mu l, 0.55 (0.41-0.74) for 350 to less than 500 cells/mu l, and 0.77 (0.58-1.01) for 500 cells/mu l or more. The estimated hazard ratio varied with years since initiation of cART from 0.57 (0.49-0.67) for less than I year since initiation to 0.21 (0.14-0.31) for 5 years or more (P value for trend <0.001).Conclusion: We estimated that cART halved the average mortality rate in HIV-infected individuals. The mortality reduction was greater in those with worse prognosis at the start Of follow-up. (C) 2010 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins

Type: Article
Title: The effect of combined antiretroviral therapy on the overall mortality of HIV-infected individuals
DOI: 10.1097/QAD.0b013e3283324283
Keywords: antiretroviral therapy, HIV infection, inverse probability weighting, marginal structural models, mortality, IMMUNODEFICIENCY-VIRUS-INFECTION, MARGINAL STRUCTURAL MODELS, CD4 CELL COUNT, CLINICAL-TRIALS, COLLABORATIVE ANALYSIS, PROSPECTIVE COHORT, SURVIVAL, PROGRESSION, AIDS, ZIDOVUDINE
UCL classification: UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Infection and Immunity
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Inst of Clinical Trials and Methodology
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Inst of Clinical Trials and Methodology > MRC Clinical Trials Unit at UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute for Global Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute for Global Health > Infection and Population Health
URI: http://discovery.ucl.ac.uk/id/eprint/1298472
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