Opportunistic Diseases as Measure of Immunodeficiency in HIV Infection

Leeuwen, R. van; Hurk, P. J. van den; Mulder, Jan; Roos, M. T. L.; Schellekens, P. T. A.; Reiss, Peter; Lange, Joep M. A.

doi:10.1159/000421345

Cited by 3 publications

(1 citation statement)

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“…We have restricted the analysis to primary CDC-C events in our cohort study. Together, they represent a range of immunosuppression levels characteristic for the development of AIDS [25]. The overall hazard of AIDS conditional on CD4 cell count might be reasonably well approximated by our uncensored estimates if we can assume a similar pathogenesis in resource-poor environments.…”

Section: Discussionmentioning

confidence: 88%

Low versus High CD4 Cell Count as Starting Point for Introduction of Antiretroviral Treatment in Resource-Poor Settings: A Scenario-Based Analysis

et al. 2003

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Objective To evaluate CD4 cell count-driven strategies for the initiation of highly active antiretroviral therapy (HAART) in terms of the reduction of the incidence of AIDS-defining events in resource-poor settings. Methods Data from the Amsterdam Cohort Study on HIV infection and AIDS were used to estimate the hazard of AIDS in untreated HIV-1 infection and after initiation of HAART, respectively, conditional on CD4 cell count. Different strategies for initiating therapy were compared by calculating the expected HAART administration rate and 1-year cumulative AIDS incidence in three different population settings, varying in the stage of HIV-1 infection at the time of presentation. Results Among 695 HIV-1-infected cohort participants, the 1-year AIDS incidence density (ID) ranged from 3.2 per 100 person-years for CD4 cell counts 600–700 cells/mm3, to 31.9 per 100 person-years for CD4 cell counts 100–200 cells/mm3 and 77.9 per 100 person-years for CD4 cell counts below 100 cells/mm3. Upon initiation of HAART, the ID in the lowest CD4 strata declined to 13.3 and 16.3 per 100 person-years, respectively. Extrapolated to developing countries, supply of HAART to patients presenting with HIV-1 infection below 200 CD4 cells/mm3 is expected to give an administration rate of 67%, while the AIDS incidence will drop from over 30% to almost 10%. Conclusions Introduction of HAART in populations with advanced HIV-1 infection can accomplish a threefold reduction of the AIDS incidence when HAART is administered to patients with CD4 cell counts below 200 cells/mm3. In a hospital-based setting in resource-poor environments this ensures an efficient treatment allocation.

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Section: Discussionmentioning

confidence: 88%

Low versus High CD4 Cell Count as Starting Point for Introduction of Antiretroviral Treatment in Resource-Poor Settings: A Scenario-Based Analysis

et al. 2003

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Additive or Sequential Nucleoside Analogue Therapy Compared with Continued Zidovudine Monotherapy in Human Immunodeficiency Virus‐Infected Patients with Advanced Disease Does Not Prolong Survival: An Observational Study

Leeuwen¹,

Bonsel²,

Reiss³

et al. 1997

J INFECT DIS

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To study the effect of sequential or additive use of zalcitabine or didanosine on survival in 308 human immunodeficiency virus -infected patients with advanced disease treated with zidovudine, an observational study using time-dependent Cox proportional hazards models was done. Changing to sequential or additive therapy was based on deterioration of a patient's health status, a significant drop in CD4 cell count, or intolerance for zidovudine. The median CD4 cell count at baseline was 110 1 10 6 /L; 42% of patients had AIDS. The median count before a change in therapy was 50 1 10 6 /L. Additive or sequential treatment was associated with an increased risk for death (relative hazard, 1.59; 95% confidence interval [CI], 1.01 -2.49; and 1.58; 95% CI, 1.10 -2.37, respectively). Adjustment of the models for prognostic factors failed to substantially affect this observation. Possibly the lack of benefit in this study is because patients switched therapy at advanced stages, whereas the switch may be more effective in early disease.

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T Cell Function In Vitro Is An Independent Progression Marker For Aids In Human Immunodeficiency Virus-Infected Asymptomatic Subjects

Roos

Miedema²,

Koot³

et al. 1995

Journal of Infectious Diseases

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The predictive value of low T cell reactivity to CD3 monoclonal antibodies for development of AIDS was evaluated and compared with low CD4+ cell numbers and the presence of syncytium-inducing human immunodeficiency virus (HIV) variants in 122 seropositive asymptomatic homosexual men for 4.5 years. Low T cell reactivity was a strong predictor for progression to AIDS in a multivariate proportional hazards analysis using these markers as covariates at entry and as time-dependent covariates. The combination of the three markers was associated with development of AIDS in 6 of 7 men within 15 months. In contrast, the group that lacked any of these markers had a very low risk (11%) for developing AIDS. In groups with one or two of these three markers, progression rates were 33% and 66%, respectively. These data demonstrate that measurement of T cell function in vitro is of value for staging of HIV infection and may be useful for monitoring therapy.

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Opportunistic Diseases as Measure of Immunodeficiency in HIV Infection

Cited by 3 publications

References 0 publications

Low versus High CD4 Cell Count as Starting Point for Introduction of Antiretroviral Treatment in Resource-Poor Settings: A Scenario-Based Analysis

Low versus High CD4 Cell Count as Starting Point for Introduction of Antiretroviral Treatment in Resource-Poor Settings: A Scenario-Based Analysis

Additive or Sequential Nucleoside Analogue Therapy Compared with Continued Zidovudine Monotherapy in Human Immunodeficiency Virus‐Infected Patients with Advanced Disease Does Not Prolong Survival: An Observational Study

T Cell Function In Vitro Is An Independent Progression Marker For Aids In Human Immunodeficiency Virus-Infected Asymptomatic Subjects

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