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Survival Outcomes and Effect of Early vs. Deferred cART Among HIV-Infected Patients Diagnosed at the Time of an AIDS-Defining Event: A Cohort Analysis

Miro, JM; Manzardo, C; Mussini, C; Johnson, M; Monforte, AD; Antinori, A; Gill, MJ; ... Late Presenters Investigators, ; + view all (2011) Survival Outcomes and Effect of Early vs. Deferred cART Among HIV-Infected Patients Diagnosed at the Time of an AIDS-Defining Event: A Cohort Analysis. PLOS ONE , 6 (10) , Article e26009. 10.1371/journal.pone.0026009. Green open access

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Abstract

Objectives: We analyzed clinical progression among persons diagnosed with HIV at the time of an AIDS-defining event, and assessed the impact on outcome of timing of combined antiretroviral treatment (cART).Methods: Retrospective, European and Canadian multicohort study.. Patients were diagnosed with HIV from 1997-2004 and had clinical AIDS from 30 days before to 14 days after diagnosis. Clinical progression (new AIDS event, death) was described using Kaplan-Meier analysis stratifying by type of AIDS event. Factors associated with progression were identified with multivariable Cox regression. Progression rates were compared between those starting early (<30 days after AIDS event) or deferred (30-270 days after AIDS event) cART.Results: The median (interquartile range) CD4 count and viral load (VL) at diagnosis of the 584 patients were 42 (16, 119) cells/mu L and 5.2 (4.5, 5.7) log(10) copies/mL. Clinical progression was observed in 165 (28.3%) patients. Older age, a higher VL at diagnosis, and a diagnosis of non-Hodgkin lymphoma (NHL) (vs. other AIDS events) were independently associated with disease progression. Of 366 patients with an opportunistic infection, 178 (48.6%) received early cART. There was no significant difference in clinical progression between those initiating cART early and those deferring treatment (adjusted hazard ratio 1.32 [95% confidence interval 0.87, 2.00], p = 0.20).Conclusions: Older patients and patients with high VL or NHL at diagnosis had a worse outcome. Our data suggest that earlier initiation of cART may be beneficial among HIV-infected patients diagnosed with clinical AIDS in our setting.

Type: Article
Title: Survival Outcomes and Effect of Early vs. Deferred cART Among HIV-Infected Patients Diagnosed at the Time of an AIDS-Defining Event: A Cohort Analysis
Open access status: An open access version is available from UCL Discovery
DOI: 10.1371/journal.pone.0026009
Publisher version: http://dx.doi.org/10.1371/journal.pone.0026009
Language: English
Additional information: © 2011 Miro et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. This work was partially supported by Istituto Superiore di Sanità, VI Programma Nazionale di ricerca sull'AIDS 2006, Italy, Projects: “Eziopatogenesi, studi immunologici e virologici dell'HIV/AIDS” - Grant: 40G.43 (Mussini), “Ricerca clinica e terapia della malattia da HIV” - Grant 30G.3 (Antinori), by the “Fundación Máximo Soriano Jiménez” (Barcelona, Spain) and the “Red Temática Cooperativa de Grupos de Investigación en Sida del Fondo de Investigación Sanitaria (FIS),” and grant ISCIII-RETIC RD06/006 from the Instituto de Salud Carlos III, Madrid (Spain)(Manzardo, Miro). Dr. Miró was a recipient of an INT10/219 Intensification Research Grant (I3SNS & PRICS programs) from the “Instituto de Salud Carlos III, Madrid (Spain)” and the “Departament de Salut de la Generalitat de Catalunya, Barcelona (Spain)”. No additional external funding received for this study. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Keywords: ACTIVE ANTIRETROVIRAL THERAPY, INDIVIDUALS, TUBERCULOSIS, INITIATION, ERA
UCL classification: UCL
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 Population Health Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health > Infection and Population Health
URI: https://discovery.ucl.ac.uk/id/eprint/1331760
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