Improved Outcomes with Earlier Initiation of Highly Active Antiretroviral Therapy Among Human Immunodeficiency Virus–Infected Patients Who Achieve Durable Virologic Suppression: Longer Follow‐Up of an Observational Cohort Study

Abstract

On the basis of studies with relatively short follow-up, treatment guidelines currently recommend that highly active antiretroviral therapy (HAART) be initiated in asymptomatic human immunodeficiency virus-infected patients when the CD4+ lymphocyte count is < or =200 cells/mm3. We assessed the development of a new opportunistic infection or death among 1173 patients initiating HAART. Durable virologic suppression was defined as having more undetectable (<400 copies/mL) than detectable virus loads after the initiation of therapy. The median durations of therapy and follow-up were 29 and 36 months, respectively. Among patients who achieved durable virologic suppression, those with baseline CD4+ lymphocyte counts of <200 cells/mm3 tended to progress faster than those with baseline CD4+ lymphocyte counts of 201-350 cells/mm3 (P=.09) and progressed faster than those with baseline CD4+ lymphocyte counts of >350 cells/mm3 (P=.01). Among those with durable virologic suppression, there was no difference in disease progression between those with baseline CD4+ lymphocyte counts of 201-350 cells/mm3 and those with durable virologic suppression with baseline CD4+ lymphocyte counts of >350 cells/mm3 (P=.40). Initiating HAART with a CD4+ lymphocyte count of <200 cells/mm3 was associated with a higher risk of disease progression, even with durable virologic suppression. HAART should be initiated at CD4+ lymphocyte counts of >200 cells/mm3.

Predictors of Virological Outcome and Safety in Primary HIV Type 1-Infected Patients Initiating Quadruple Antiretroviral Therapy: QUEST GW PROB3005

“…It is unclear whether initiation of potent antiretroviral therapy (ART) during primary HIV-1 infection (PHI) can alter long-term prognosis [1][2][3][4][5]. Early ART can gence of resistance in noncompliant patients.…”

Impact of highly active antiretroviral therapy (HAART) on the incidence of opportunistic infections, hospitalizations and mortality among children and adolescents living with HIV/AIDS in Belo Horizonte, Minas Gerais State, Brazil

“…Decreases in hospitalizations and deaths result in a substantial reduction in health care costs associated with infected patients. Worldwide, there have been very few studies 6,7,8 carried out regarding the impact of HAART therapy on vertically infected children and adolescents, none of them in the Brazilian population.…”

Antiretroviral Therapy in the Clinic

“…Increasing evidence suggests a reduction in death, opportunistic infections, and serious non-AIDS events and an increase in rates of maximal virologic suppression and CD4 cell counts in patients who initiate therapy with CD4 counts between 200 to 350 cells/l (5,10,16,20,29,30,38,43,49,53,57,67). Data from a large observational cohort recently demonstrated an increased risk of death in patients who did not initiate antiretroviral therapy with CD4 counts either between 351 to 500 cells/l or of Ͼ500 cells/l relative to patients in those CD4 strata that did initiate therapy (26).…”