Timing of HAART initiation and clinical outcomes in human immunodeficiency virus type 1 seroconverters

Michele Jonsson Funk, Jennifer S. Fusco, Stephen R. Cole, James C. Thomas, Kholoud Porter, Jay S. Kaufman, Marie Davidian, Alice D. White, Katherine E. Hartmann, Joseph J. Eron

Research output: Contribution to journalArticlepeer-review

99 Scopus citations

Abstract

Background: To estimate the clinical benefit of highly active antiretroviral therapy (HAART) initiation vs deferral in a given month in patients with CD4 cell counts less than 800/μL. Methods: In this observational cohort study of human immunodeficiency virus type 1 seroconverters from CASCADE (Concerted Action on SeroConversion to AIDS and Death in Europe), we constructed monthly sequential nested subcohorts between January 1996 and May 2009, including all eligible HAART-naive, AIDS-free individuals with a CD4 cell count less than 800/μL. The primary outcome was time to AIDS or death in those who initiated HAART in the baseline month compared with those who did not, pooled across subcohorts and stratified by CD4 cell count. Using inverse probability-oftreatment weighted survival curves and Cox proportional hazards regression models, we estimated the absolute and relative effects of treatment with robust 95% confidence intervals (CIs). Results: Of 9455 patients with 52 268 person-years of follow-up, 812 (8.6%) developed AIDS and 544 (5.8%) died. In CD4 cell count strata of 200 to 349, 350 to 499, and 500 to 799/μL, HAART initiation was associated with adjusted hazard ratios (95% CIs) for AIDS/death of 0.59 (0.43-0.81), 0.75 (0.49-1.14), and 1.10 (0.67-1.79), respectively. In the analysis of all-cause mortality, HAART initiationwas associated with adjusted hazard ratios (95% CIs) of 0.71 (0.44-1.15), 0.51 (0.33-0.80), and 1.02 (0.49-2.12), respectively. Numbers needed to treat (95% CIs) to prevent 1 AIDS event or death within 3 years were 21 (14-38) and 34 (20-115) in CD4 cell count strata of 200 to 349 and 350 to 499/μL, respectively. Conclusion: Compared with deferring in a given month, HAART initiation at CD4 cell counts less than 500/μL (but not 500-799/μL) was associated with slower disease progression.

Original languageEnglish
Pages (from-to)1560-1569
Number of pages10
JournalArchives of Internal Medicine
Volume171
Issue number17
DOIs
StatePublished - Sep 26 2011

ASJC Scopus subject areas

  • Internal Medicine

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