Impact of earlier HAART initiation on the immune status and clinical course of treated patients on the basis of cohort data of the German Competence Network for HIV/AIDS

Plettenberg, Andreas; Brockmeyer, N. H.; Haastert, Burkhard; Michalik, Claudia; Dupke, S; Schewe, Knud; Rausch, Michael; Hower, Martin; Ulmer, Albrecht; Wolf, Eva; Lorenzen, Thore; Arendt, Gabriele; Jansen, Klaus

doi:10.1007/s15010-010-0070-8

Cited by 13 publications

(10 citation statements)

References 34 publications

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“…Despite nearly 15 years of experience with antiretroviral therapy for the treatment of HIV-positive individuals, consensus on the optimal time to initiate HAART has yet to be reached [82]. Aggressive early treatment in the course of infection was initially purported to present significant side effect risks and development of drug resistance [83].…”

Section: Discussionmentioning

confidence: 99%

“…Aggressive early treatment in the course of infection was initially purported to present significant side effect risks and development of drug resistance [83]. Plettenburg et al [82] recently identified that initiation of HAART in patients with higher CD4 counts correlated with improved outcomes. Aggressive and early treatment, even in asymptomatic HIV-positive patients, is recommended by most clinicians [84].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Impact of Human Immunodeficiency Virus in the Pathogenesis and Outcome of Patients with Glioblastoma Multiforme

Choy

Lagman

Lee

et al. 2016

Brain Tumor Res Treat

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BackgroundImprovement in antiviral therapies have been accompanied by an increased frequency of non-Acquired Immune Deficiency Syndrome (AIDS) defining malignancies, such as glioblastoma multiforme. Here, we investigated all reported cases of human immunodeficiency virus (HIV)-positive patients with glioblastoma and evaluated their clinical outcomes. A comprehensive review of the molecular pathogenetic mechanisms underlying glioblastoma development in the setting of HIV/AIDS is provided.MethodsWe performed a PubMed search using keywords “HIV glioma” AND “glioblastoma,” and “AIDS glioma” AND “glioblastoma.” Case reports and series describing HIV-positive patients with glioblastoma (histologically-proven World Health Organization grade IV astrocytoma) and reporting on HAART treatment status, clinical follow-up, and overall survival (OS), were included for the purposes of quantitative synthesis. Patients without clinical follow-up data or OS were excluded. Remaining articles were assessed for data extraction eligibility.ResultsA total of 17 patients met our inclusion criteria. Of these patients, 14 (82.4%) were male and 3 (17.6%) were female, with a mean age of 39.5±9.2 years (range 19–60 years). Average CD4 count at diagnosis of glioblastoma was 358.9±193.4 cells/mm3. Tumor progression rather than AIDS-associated complications dictated patient survival. There was a trend towards increased median survival with HAART treatment (12.0 vs 7.5 months, p=0.10)ConclusionOur data suggests that HAART is associated with improved survival in patients with HIV-associated glioblastoma, although the precise mechanisms underlying this improvement remain unclear.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Impact of Human Immunodeficiency Virus in the Pathogenesis and Outcome of Patients with Glioblastoma Multiforme

Choy

Lagman

Lee

et al. 2016

Brain Tumor Res Treat

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“…Only one trial has randomized people with a CD4 cell count >350 cells/μL, but this used a comparator arm of delay of initiation of ARVs until the CD4 cell count has fallen below 250 cells/μL, and thus is likely to overestimate the apparent benefits of immediate treatment compared with starting at <350 cells/μL. There have been a number of observational studies that have attempted to address this issue , which have produced conflicting findings. Some of these studies have failed to take into account the lead time between an individual's CD4 cell count falling below the threshold for treatment and the date of starting treatment ; as this may introduce serious bias into treatment comparisons, these results do not resolve the question whether it is better to start ART at higher CD4 cell counts.…”

Section: Chronic Infectionmentioning

confidence: 99%

“…There have been a number of observational studies that have attempted to address this issue , which have produced conflicting findings. Some of these studies have failed to take into account the lead time between an individual's CD4 cell count falling below the threshold for treatment and the date of starting treatment ; as this may introduce serious bias into treatment comparisons, these results do not resolve the question whether it is better to start ART at higher CD4 cell counts.…”

Section: Chronic Infectionmentioning

confidence: 99%

4.0 When to start

2013

HIV Medicine

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“…There may be additional challenges for ART uptake and adherence for HIV-positive MSM with high CD4 levels, as both Chinese and international data suggest that higher CD4 level is associated with lower ART coverage [11,12]. Since PLWH with CD4 levels> 350 cells/mm 3 have only recently become eligible to receive free ART after the updating of national guidelines, the ART coverage of this group may be an indicator of whether guidelines are being successfully implemented. Prior to the updating of national ART guidelines, a cross-sectional study reported that only 18% of HIV-positive MSM with CD4 levels> 350 cells/mm 3 were on ART [13].…”

Section: Introductionmentioning

confidence: 99%

Coverage and adherence of antiretroviral therapy among Chinese HIV‐positive men who have sex with men with high CD4 counts in the era of ‘Treat all’

Yang

Wang

Harrison

et al. 2019

Tropical Med Int Health

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Objectives HIV‐positive men who have sex with men (MSM) with CD4 cell counts> 350 cells/mm3 in China recently became eligible for free antiretroviral therapy (ART) due to updated national guidelines. This study aimed to investigate ART coverage and adherence among a large sample of HIV‐positive MSM in China. Methods A cross‐sectional survey was conducted in Chengdu and Hangzhou, China, from February to November 2016. Participants were 277 MSM who had received a confirmatory HIV diagnosis and had CD4 levels of> 350 cells/mm3. Trained staff of collaborating non‐governmental organizations contacted all HIV‐positive MSM listed in their service records and invited them to join the study. The ART initiation, ART adherence and interactions between healthcare professionals and the patients were assessed. Results ART coverage was 60.3%. Among those who were on ART (n = 167), no participants reported missing any doses in the last four days, but 25.7% reported non‐compliance to either ART dosing schedule or dosage instructions. After adjusting for background variables and perceived eligibility for ART, two variables were significant factors of higher ART coverage: (i) receiving a recommendation from healthcare professionals for immediate ART initiation and (ii) perceiving having received an adequate explanation of potential harms of ART. Being prescribed> 3 pills per dose and not having a temporary resident permit were associated with non‐compliance. Conclusions Significant efforts are needed to increase ART coverage among HIV‐positive MSM with high CD4 counts in China. Although prevalence of missing doses was low, non‐compliance to dosing schedule/instructions should not be neglected. Interactions between healthcare professionals and MSMs play an important role in facilitating ART initiation.

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Impact of earlier HAART initiation on the immune status and clinical course of treated patients on the basis of cohort data of the German Competence Network for HIV/AIDS

Abstract: The results gave a strong hint for a therapy initiation at higher CD4-cell-count/μl regarding the outcome of death in treated patients. A distinct benefit was shown regarding the first decline of CD4-cell-count/μl below 200.

Cited by 13 publications

References 34 publications

Impact of Human Immunodeficiency Virus in the Pathogenesis and Outcome of Patients with Glioblastoma Multiforme

Impact of Human Immunodeficiency Virus in the Pathogenesis and Outcome of Patients with Glioblastoma Multiforme

4.0 When to start

Coverage and adherence of antiretroviral therapy among Chinese HIV‐positive men who have sex with men with high CD4 counts in the era of ‘Treat all’

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