Περίληψη:
Background: Clinical guidelines recommend immediate initiation of combined antiretroviral therapy for all HIV-positive individuals. However, those guidelines are based on trials of relatively young participants. Methods: We included HIV-positive antiretroviral therapy-naive, AIDS-free individuals aged 50-70 years after 2004 in the HIV-CAUSAL Collaboration. We used the parametric g-formula to estimate the 5-year risk of all-cause and non-AIDS mortality under (1) immediate initiation at baseline and initiation at CD4 count, (2) <500 cells/mm 3, and (3) <350 cells/mm 3. Results were presented separately for the general HIV population and for a US Veterans cohort with high mortality. Results: The study included 9596 individuals (28% US Veterans) with median (interquantile range) age of 55 (52-60) years and CD4 count of 336 (182-513) at baseline. The 5-year risk of all-cause mortality was 0.40% (95% confidence interval (CI): 0.10 to 0.71) lower for the general HIV population and 1.61% (95% CI: 0.79 to 2.67) lower for US Veterans when comparing immediate initiation vs initiation at CD4 <350 cells/mm 3. The 5-year risk of non-AIDS mortality was 0.17% (95% CI: -0.07 to 0.43) lower for the general HIV population and 1% (95% CI: 0.31 to 2.00) lower for US Veterans when comparing immediate initiation vs initiation at CD4 <350 cells/mm 3. Conclusions: Immediate initiation seems to reduce all-cause and non-AIDS mortality in patients aged 50-70 years. Copyright © 2017 The Author(s). Published by Wolters Kluwer Health, Inc.
Συγγραφείς:
Lodi, S.
Costagliola, D.
Sabin, C.
Del Amo, J.
Logan, R.
Abgrall, S.
Reiss, P.
Van Sighem, A.
Jose, S.
Blanco, J.-R.
Hernando, V.
Bucher, H.C.
Kovari, H.
Segura, F.
Ambrosioni, J.
Gogos, C.A.
Pantazis, N.
Dabis, F.
Vandenhende, M.-A.
Meyer, L.
Seng, R.
Gill, M.J.
Krentz, H.
Phillips, A.N.
Porter, K.
Grinsztejn, B.
Pacheco, A.G.
Muga, R.
Tate, J.
Justice, A.
Hernán, M.A.
Λέξεις-κλειδιά:
integrase inhibitor; nonnucleoside reverse transcriptase inhibitor; proteinase inhibitor; RNA directed DNA polymerase inhibitor; virus fusion inhibitor; anti human immunodeficiency virus agent, adult; age; aged; all cause mortality; antiretroviral therapy; CD4 lymphocyte count; Conference Paper; female; human; Human immunodeficiency virus infected patient; Human immunodeficiency virus infection; major clinical study; male; priority journal; sex difference; veteran; drug administration; epidemiology; highly active antiretroviral therapy; HIV Infections; middle aged; mortality; regression analysis; United States; virology; virus load, Aged; Anti-HIV Agents; Antiretroviral Therapy, Highly Active; CD4 Lymphocyte Count; Drug Administration Schedule; Female; HIV Infections; Humans; Male; Middle Aged; Regression Analysis; United States; Viral Load
