Abstract
| Originalsprog | Engelsk |
|---|---|
| Tidsskrift | Journal of Infectious Diseases |
| Vol/bind | 197 |
| Udgave nummer | 8 |
| Sider (fra-til) | 1145-55 |
| Antal sider | 10 |
| ISSN | 0022-1899 |
| DOI | |
| Status | Udgivet - 2008 |
Bibliografisk note
Keywords: AIDS-Related Opportunistic Infections; Anti-HIV Agents; CD4 Lymphocyte Count; Drug Administration Schedule; HIV; HIV Infections; Humans; Proportional Hazards Models; RNA, Viral; Treatment OutcomeAdgang til dokumentet
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Inferior clinical outcome of the CD4+ cell count-guided antiretroviral treatment interruption strategy in the SMART study: role of CD4+ Cell counts and HIV RNA levels during follow-up. / Lundgren, Jens; Babiker, Abdel; El-Sadr, Wafaa; Emery, Sean; Grund, Birgit; Neaton, James D; Neuhaus, Jacquie; Phillips, Andrew N; Strategies for Management of Antiretroviral Therapy (SMART) Study Group.
I: Journal of Infectious Diseases, Bind 197, Nr. 8, 2008, s. 1145-55.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › peer review
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TY - JOUR
T1 - Inferior clinical outcome of the CD4+ cell count-guided antiretroviral treatment interruption strategy in the SMART study: role of CD4+ Cell counts and HIV RNA levels during follow-up
AU - Lundgren, Jens
AU - Babiker, Abdel
AU - El-Sadr, Wafaa
AU - Emery, Sean
AU - Grund, Birgit
AU - Neaton, James D
AU - Neuhaus, Jacquie
AU - Phillips, Andrew N
AU - Strategies for Management of Antiretroviral Therapy (SMART) Study Group
N1 - Keywords: AIDS-Related Opportunistic Infections; Anti-HIV Agents; CD4 Lymphocyte Count; Drug Administration Schedule; HIV; HIV Infections; Humans; Proportional Hazards Models; RNA, Viral; Treatment Outcome
PY - 2008
Y1 - 2008
N2 - BACKGROUND AND METHODS: The SMART study compared 2 strategies for using antiretroviral therapy-drug conservation (DC) and viral suppression (VS)-in 5,472 human immunodeficiency virus (HIV)-infected patients with CD4+ cell counts >350 cells/microL. Rates and predictors of opportunistic disease or death (OD/death) and the relative risk (RR) in DC versus VS groups according to the latest CD4+ cell count and HIV RNA level are reported. RESULTS: During a mean of 16 months of follow-up, DC patients spent more time with a latest CD4+ cell count <350 cells/microL (for DC vs. VS, 31% vs. 8%) and with a latest HIV RNA level >400 copies/mL (71% vs. 28%) and had a higher rate of OD/death (3.4 vs. 1.3/100 person-years) than VS patients. For periods of follow- up with a CD4+ cell count <350 cells/microL, rates of OD/death were increased but similar in the 2 groups (5.7 vs. 4.6/100 person-years), whereas the rates were higher in DC versus VS patients (2.3 vs. 1.0/100 person-years; RR, 2.3 [95% confidence interval, 1.5-3.4]) for periods with the latest CD4+ cell count >or= 350 cells/microL-an increase explained by the higher HIV RNA levels in the DC group. CONCLUSIONS: The higher risk of OD/death in DC patients was associated with (1) spending more follow-up time with relative immunodeficiency and (2) living longer with uncontrolled HIV replication even at higher CD4+ cell counts. Ongoing HIV replication at a given CD4+ cell count places patients at an excess risk of OD/death.
AB - BACKGROUND AND METHODS: The SMART study compared 2 strategies for using antiretroviral therapy-drug conservation (DC) and viral suppression (VS)-in 5,472 human immunodeficiency virus (HIV)-infected patients with CD4+ cell counts >350 cells/microL. Rates and predictors of opportunistic disease or death (OD/death) and the relative risk (RR) in DC versus VS groups according to the latest CD4+ cell count and HIV RNA level are reported. RESULTS: During a mean of 16 months of follow-up, DC patients spent more time with a latest CD4+ cell count <350 cells/microL (for DC vs. VS, 31% vs. 8%) and with a latest HIV RNA level >400 copies/mL (71% vs. 28%) and had a higher rate of OD/death (3.4 vs. 1.3/100 person-years) than VS patients. For periods of follow- up with a CD4+ cell count <350 cells/microL, rates of OD/death were increased but similar in the 2 groups (5.7 vs. 4.6/100 person-years), whereas the rates were higher in DC versus VS patients (2.3 vs. 1.0/100 person-years; RR, 2.3 [95% confidence interval, 1.5-3.4]) for periods with the latest CD4+ cell count >or= 350 cells/microL-an increase explained by the higher HIV RNA levels in the DC group. CONCLUSIONS: The higher risk of OD/death in DC patients was associated with (1) spending more follow-up time with relative immunodeficiency and (2) living longer with uncontrolled HIV replication even at higher CD4+ cell counts. Ongoing HIV replication at a given CD4+ cell count places patients at an excess risk of OD/death.
U2 - 10.1086/529523
DO - 10.1086/529523
M3 - Journal article
C2 - 18476293
VL - 197
SP - 1145
EP - 1155
JO - Journal of Infectious Diseases
JF - Journal of Infectious Diseases
SN - 0022-1899
IS - 8
ER -