Περίληψη:
Objective: To illustrate an approach to compare CD4 cell count and
HIV-RNA monitoring strategies in HIV-positive individuals on
antiretroviral therapy (ART).
Design: Prospective studies of HIV-positive individuals in Europe and
the USA in the HIV-CAUSAL Collaboration and The Center for AIDS Research
Network of Integrated Clinical Systems.
Methods: Antiretroviral-naive individuals who initiated ART and became
virologically suppressed within 12 months were followed from the date of
suppression. We compared 3 CD4 cell count and HIV-RNA monitoring
strategies: once every (1) 3 +/- 1 months, (2) 6 +/- 1 months, and (3)
9-12 +/- 1 months. We used inverseprobability weighted models to compare
these strategies with respect to clinical, immunologic, and virologic
outcomes.
Results: In 39,029 eligible individuals, there were 265 deaths and 690
AIDS-defining illnesses or deaths. Compared with the 3-month strategy,
the mortality hazard ratios (95% CIs) were 0.86 (0.42 to 1.78) for the
6 months and 0.82 (0.46 to 1.47) for the 9-12 month strategy. The
respective 18-month risk ratios (95% CIs) of virologic failure (RNA
>200) were 0.74 (0.46 to 1.19) and 2.35 (1.56 to 3.54) and 18-month mean
CD4 differences (95% CIs) were -25.3 (-18.6 to 7.9) and -31.7 (-52.0 to
-11.3). The estimates for the 2-year risk of AIDS-defining illness or
death were similar across strategies.
Conclusions: Our findings suggest that monitoring frequency of
virologically suppressed individuals can be decreased from every 3
months to every 6, 9, or 12 months with respect to clinical outcomes.
Because effects of different monitoring strategies could take years to
materialize, longer follow-up is needed to fully evaluate this question.
Συγγραφείς:
Caniglia, Ellen C.
Sabin, Caroline
Robins, James M.
Logan,
Roger
Cain, Lauren E.
Abgrall, Sophie
Mugavero, Michael J.
and Hernandez-Diaz, Sonia
Meyer, Laurence
Seng, Remonie and
Drozd, Daniel R.
Seage, III, George R.
Bonnet, Fabrice and
Dabis, Francois
Moore, Richard R.
Reiss, Peter
van Sighem,
Ard
Mathews, William C.
del Amo, Julia
Moreno, Santiago and
Deeks, Steven G.
Muga, Roberto
Boswell, Stephen L.
Ferrer,
Elena
Eron, Joseph J.
Napravnik, Sonia
Jose, Sophie and
Phillips, Andrew
Olson, Ashley
Justice, Amy C.
Tate, Janet
P.
Bucher, Heiner C.
Egger, Matthias
Touloumi, Giota and
Sterne, Jonathan A.
Costagliola, Dominique
Saag, Michael and
Hernan, Miguel A.
Ctr AIDS Res Network Integrated
