دورية أكاديمية
Long-Term Benefits from Early Antiretroviral Therapy Initiation in HIV Infection.
| العنوان: | Long-Term Benefits from Early Antiretroviral Therapy Initiation in HIV Infection. |
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| المؤلفون: | Lundgren JD; CHIP Centre of Excellence for Health, Immunity, and Infections, Department of Infectious Diseases, Rigshospitalet, Copenhagen., Babiker AG; Medical Research Council Clinical Trials Unit, University College London, London., Sharma S; Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis., Grund B; School of Statistics, University of Minnesota, Minneapolis., Phillips AN; Institute for Global Health, University College London, London., Matthews G; Kirby Institute, Sydney., Kan VL; VA Medical Center, Washington, D.C., Aagaard B; CHIP Centre of Excellence for Health, Immunity, and Infections, Department of Infectious Diseases, Rigshospitalet, Copenhagen., Abo I; Helsinki University Central Hospital, Helsinki., Alston B; Division of AIDS, National Institute of Allergy and Infectious Diseases, Bethesda, MD., Arenas-Pinto A; Medical Research Council Clinical Trials Unit, University College London, London., Avihingsanon A; Thai Red Cross AIDS Research Centre, Bangkok, Thailand., Badal-Faesen S; Clinical HIV Research Unit, Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg., Brites C; Hospital Universitario Professor Edgard Santos, School of Medicine, Federal University of Bahia, Salvador, Brazil., Carey C; Kirby Institute, Sydney., Casseb J; Laboratory of Medical Investigation - LIM56, Faculty of Medicine, Department of Dermatology, University of São Paulo, São Paulo., Clarke A; Royal Sussex County Hospital, Brighton, United Kingdom., Collins S; HIV i-Base, London., Corbelli GM; European AIDS Treatment Group, Brussels., Dao S; Mali-National Institute of Allergy and Infectious Diseases HIV Research Initiative, Bamako, Mali., Denning ET; Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis., Emery S; UNSW Medicine, Sydney., Eriobu N; Institute of Human Virology Nigeria, Abuja, Nigeria., Florence E; Institute of Tropical Medicine, Antwerp, Belgium., Furrer H; Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland., Fätkenheuer G; Klinik I für Innere Medizin der Universität zu Köln, Cologne, Germany., Gerstoft J; Rigshospitalet, Infektionsmedicinsk ambulatorium 8622, Copenhagen., Gisslén M; Sahlgrenska University Hospital, Gothenburg, Sweden., Goodall K; Medical Research Council Clinical Trials Unit, University College London, London., Henry K; Hennepin Health Research Institute, Minneapolis., Horban A; Wojewódzki Szpital Zakaźny, Warsaw, Poland., Hoy J; Department of Infectious Diseases, The Alfred Hospital and Monash University, Melbourne, VIC, Australia., Hudson F; Medical Research Council Clinical Trials Unit, University College London, London., Azwa RISR; University Malaya Medical Centre, Kuala Lumpur, Malaysia., Kedem E; Rambam Medical Center, Haifa, Israel., Kelleher A; Kirby Institute, Sydney., Kityo C; Joint Clinical Research Centre, Kampala, Uganda., Klingman K; Division of AIDS, National Institute of Allergy and Infectious Diseases, Bethesda, MD., Rosa A; Asociación Civil IMPACTA Salud y Educación, Lima, Peru., Leturque N; INSERM SC10-US19, Villejuif, Paris., Lifson AR; University of Minnesota, Minneapolis., Losso M; Hospital General de Agudos J.M. Ramos Mejia, Buenos Aires., Lutaakome J; MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda., Madero JS; Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City., Mallon P; Centre for Experimental Pathogen Host Research, University College Dublin, Dublin., Mansinho K; Hospital de Egas Moniz, Lisbon, Portugal., Filali KME; University Hospital Centre Ibn Rochd, Casablanca, Morocco., Molina JM; Hôpital Saint-Louis, Paris., Murray DD; CHIP Centre of Excellence for Health, Immunity, and Infections, Department of Infectious Diseases, Rigshospitalet, Copenhagen., Nagalingeswaran K; Voluntary Health Services, Infectious Diseases Medical Centre, Chennai Antiviral Research and Treatment, Clinical Research Site, Chennai, India., Nozza S; Ospedale San Raffaele S.r.l., Milan., Ormaasen V; Oslo University Hospital, Ullevål, Oslo., Paredes R; Hospital Universitari Germans Trias i Pujol, Barcelona., Peireira LC; Instituto de Infectologia Emílio Ribas, São Paulo., Pillay S; Durban International Clinical Research Site, Durban, South Africa., Polizzotto MN; Clinical Hub for Interventional Research, College of Health and Medicine, The Australian National University, Canberra, ACT, Australia., Raben D; CHIP Centre of Excellence for Health, Immunity, and Infections, Department of Infectious Diseases, Rigshospitalet, Copenhagen., Rieger A; University Vienna General Hospital, Vienna., Sanchez A; VA Medical Center, Washington, D.C., Schechter M; Projeto Praça Onze, Rio de Janeiro., Sedlacek D; University Hospital Plzen, Plzen, Czech Republic., Staub T; Centre Hospitalier de Luxembourg, Luxembourg., Touloumi G; Medical School, National and Kapodistrian University of Athens, Athens., Turner M; VA Medical Center, Washington, D.C., Madruga JV; Centro de Referência e Treinamento em DST/AIDS, São Paulo., Vjecha M; VA Medical Center, Washington, D.C., Wolff M; Hospital Clínico San Borja Arriarán, Fundación Arriarán, Santiago, Chile., Wood R; Desmond Tutu Health Foundation, Cape Town, South Africa., Zilmer K; West Tallinn Central Hospital Infectious Diseases, Tallinn, Estonia., Lane HC; National Institute of Allergy and Infectious Diseases, Bethesda, MD., Neaton JD; Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis. |
| مؤلفون مشاركون: | INSIGHT Strategic Timing of AntiRetroviral Treatment (START) Study Group |
| المصدر: | NEJM evidence [NEJM Evid] 2023 Mar; Vol. 2 (3). Date of Electronic Publication: 2023 Feb 27. |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: NEJM Group, a division of the Massachusetts Medical Society Country of Publication: United States NLM ID: 9918317485806676 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2766-5526 (Electronic) Linking ISSN: 27665526 NLM ISO Abbreviation: NEJM Evid Subsets: PubMed not MEDLINE |
| أسماء مطبوعة: | Original Publication: [Waltham, MA] : NEJM Group, a division of the Massachusetts Medical Society, [2022]- |
| مستخلص: | Background: For people with HIV and CD4 + counts >500 cells/mm 3 , early initiation of antiretroviral therapy (ART) reduces serious AIDS and serious non-AIDS (SNA) risk compared with deferral of treatment until CD4 + counts are <350 cells/mm 3 . Whether excess risk of AIDS and SNA persists once ART is initiated for those who defer treatment is uncertain. Methods: The Strategic Timing of AntiRetroviral Treatment (START) trial, as previously reported, randomly assigned 4684 ART-naive HIV-positive adults with CD4 + counts .500 cells/mm 3 to immediate treatment initiation after random assignment (n = 2325) or deferred treatment (n= 2359). In 2015, a 57% lower risk of the primary end point (AIDS, SNA, or death) for the immediate group was reported, and the deferred group was offered ART. This article reports the follow-up that continued to December 31, 2021. Cox proportional-hazards models were used to compare hazard ratios for the primary end point from randomization through December 31, 2015, versus January 1, 2016, through December 31, 2021. Results: Through December 31, 2015, approximately 7 months after the cutoff date from the previous report, the median CD4 + count was 648 and 460 cells/mm 3 in the immediate and deferred groups, respectively, at treatment initiation. The percentage of follow-up time spent taking ART was 95% and 36% for the immediate and deferred groups, respectively, and the time-averaged CD4 + difference was 199 cells/mm 3 . After January 1, 2016, the percentage of follow-up time on treatment was 97.2% and 94.1% for the immediate and deferred groups, respectively, and the CD4 + count difference was 155 cells/mm 3 . After January 1, 2016, a total of 89 immediate and 113 deferred group participants experienced a primary end point (hazard ratio of 0.79 [95% confidence interval, 0.60 to 1.04] versus hazard ratio of 0.47 [95% confidence interval, 0.34 to 0.65; P<0.001]) before 2016 (P=0.02 for hazard ratio difference). Conclusions: Among adults with CD4 + counts >500 cells/mm 3 , excess risk of AIDS and SNA associated with delaying treatment initiation was diminished after ART initiation, but persistent excess risk remained. (Funded by the National Institute of Allergy and Infectious Diseases and others.). |
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| معلومات مُعتمدة: | U01 AI136780 United States AI NIAID NIH HHS |
| تواريخ الأحداث: | Date Created: 20230522 Latest Revision: 20230902 |
| رمز التحديث: | 20240829 |
| مُعرف محوري في PubMed: | PMC10194271 |
| DOI: | 10.1056/evidoa2200302 |
| PMID: | 37213438 |
| قاعدة البيانات: | MEDLINE |
| تدمد: | 2766-5526 |
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| DOI: | 10.1056/evidoa2200302 |