دورية أكاديمية
Interruption of combination antiretroviral therapy and risk of clinical disease progression to AIDS or death.
| العنوان: | Interruption of combination antiretroviral therapy and risk of clinical disease progression to AIDS or death. |
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| المؤلفون: | Holkmann Olsen C; Copenhagen HIV Programme, Hvidovre University Hospital, DK-2650 Hvidovre, Denmark. cho@cphiv.dk, Mocroft A, Kirk O, Vella S, Blaxhult A, Clumeck N, Fisher M, Katlama C, Phillips AN, Lundgren JD |
| مؤلفون مشاركون: | EuroSIDA study group |
| المصدر: | HIV medicine [HIV Med] 2007 Mar; Vol. 8 (2), pp. 96-104. |
| نوع المنشور: | Journal Article; Multicenter Study |
| اللغة: | English |
| بيانات الدورية: | Publisher: Wiley Country of Publication: England NLM ID: 100897392 Publication Model: Print Cited Medium: Print ISSN: 1464-2662 (Print) Linking ISSN: 14642662 NLM ISO Abbreviation: HIV Med Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: Oxford : Wiley Original Publication: Oxford : Blackwell Science, c1999- |
| مواضيع طبية MeSH: | HIV-1*, Anti-Retroviral Agents/*therapeutic use , HIV Infections/*drug therapy, Acquired Immunodeficiency Syndrome/epidemiology ; Acquired Immunodeficiency Syndrome/mortality ; CD4 Lymphocyte Count ; Disease Progression ; Drug Therapy, Combination ; Female ; HIV Infections/mortality ; Humans ; Incidence ; Male ; Prospective Studies ; Risk Factors ; Sex Distribution ; Time Factors ; Viral Load ; Withholding Treatment |
| مستخلص: | Objectives: The aim of the study was to compare incidence rates (IRs) of AIDS/death in patients with and without treatment interruption (TI) of combination antiretroviral therapy (cART) for periods of 3 months or more for different categories of CD4 cell count and viral load, and to determine risk factors for clinical progression to AIDS/death. Methods: Patients starting cART with a CD4 cell count and a viral load available within 6 months of starting cART were included in the study. The IR and risk factors of TI were determined. We assessed the incidence rate ratios (IRRs) for TI and AIDS/death events using Poisson regression models. Results: Of 3811 patients included in the study, 26% were ART-naïve prior to cART. The median date of starting cART was July 1997, the median CD4 cell count was 226 cells/microL and the median viral load was 4.36 log(10) HIV-1 RNA copies/mL. We observed 1243 interruptions and 403 AIDS-events/deaths. The IR of AIDS/death was higher in patients with lower CD4 cell counts or higher viral loads, regardless of TI. After adjusting for baseline factors, the IR of AIDS/death was significantly higher in the TI group than in the non-TI group [IRR 2.63; 95% confidence interval (CI) 2.01-3.44; P<0.0001]; this could be explained by current CD4 cell counts and viral loads, as the CD4 cell count- and viral load-adjusted IRR was 1.14 (95% CI 0.86-1.51; P=0.37). Within the TI group, patients with a current CD4 cell count of <200 cells/microL had a 3-fold higher risk of AIDS/death than those with a CD4 cell count of 200-350 cells/microL, whereas patients with a current CD4 cell count of >350 cells/microL had a 4-fold lower risk of disease progression. Conclusions: TI is common in clinical practice. The risk of AIDS/death increased more than 2-fold for patients stopping all cART regimen drugs for 3 months or more. Among patients experiencing a TI, those with low CD4 cell counts, high viral loads or prior AIDS had an increased risk of AIDS/death. Hence, TI should be discouraged and closely monitored if it occurs. |
| المشرفين على المادة: | 0 (Anti-Retroviral Agents) |
| تواريخ الأحداث: | Date Created: 20070314 Date Completed: 20071108 Latest Revision: 20220316 |
| رمز التحديث: | 20240628 |
| DOI: | 10.1111/j.1468-1293.2007.00436.x |
| PMID: | 17352766 |
| قاعدة البيانات: | MEDLINE |
Full Text Finder | تدمد: | 1464-2662 |
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| DOI: | 10.1111/j.1468-1293.2007.00436.x |