Virologic and immunologic response to highly active antiretroviral therapy

Jacobson, Lisa P.; Phair, John P.; Yamashita, Traci E.

doi:10.1007/s11904-004-0011-1

Cited by 8 publications

(16 citation statements)

References 51 publications

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“…The rates we observed were equivalent or slightly higher than these and were sustained for more than 5 years. Limited population and cohort studies in the U.S. have shown variable VS rates at 3 to 8 months of 50-85% and rebound at 3 years of 20-50% [26,27]. Outside the U.S., several cohorts with universal access to healthcare have demonstrated a remarkable response to HAART when compared to cohorts with similar demographics in the U.S.[3,28-31].…”

Section: Discussionmentioning

confidence: 99%

Outcomes of highly active antiretroviral therapy in the context of universal access to healthcare: the U.S. Military HIV Natural History Study

Marconi

Grandits

Weintrob

et al. 2010

AIDS Research and Therapy

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BackgroundTo examine the outcomes of highly-active antiretroviral therapy (HAART) for individuals with free access to healthcare, we evaluated 2327 patients in a cohort study composed of military personnel and beneficiaries with HIV infection who initiated HAART from 1996 to the end of 2007.MethodsOutcomes analyzed were virologic suppression (VS) and failure (VF), CD4 count changes, AIDS and death. VF was defined as never suppressing or having at least one rebound event. Multivariate (MV) analyses stratified by the HAART initiation year (before or after 2000) were performed to identify risk factors associated with these outcomes.ResultsAmong patients who started HAART after 2000, 81% had VS at 1 year (N = 1,759), 85% at 5 years (N = 1,061), and 82% at 8 years (N = 735). Five years post-HAART, the median CD4 increase was 247 cells/ml and 34% experienced VF. AIDS and mortality rates at 5 years were 2% and 0.3%, respectively. In a MV model adjusted for known risk factors associated with treatment response, being on active duty (versus retired) at HAART initiation was associated with a decreased risk of AIDS (HR = 0.6, 95% CI 0.4-1.0) and mortality (0.6, 0.3-0.9), an increased probability of CD4 increase ≥ 50% (1.2, 1.0-1.4), but was not significant for VF.ConclusionsIn this observational cohort, VS rates approach those described in clinical trials. Initiating HAART on active duty was associated with even better outcomes. These findings support the notion that free access to healthcare likely improves the response to HAART thereby reducing HIV-related morbidity and mortality.

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Section: Discussionmentioning

confidence: 99%

Outcomes of highly active antiretroviral therapy in the context of universal access to healthcare: the U.S. Military HIV Natural History Study

Marconi

Grandits

Weintrob

et al. 2010

AIDS Research and Therapy

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“…Sub-Sahara Africa is the most affected part of the world with an estimated 22.9 million people living with HIV and 1.2 million deaths from AIDS among children and adults in 2010 [1]. Immunological suppression and disturbance caused by HIV infection is responsible for the decline in CD4 cell counts and is predictive of both morbidity and mortality from AIDS [2], [3].…”

Section: Introductionmentioning

confidence: 99%

Predictors of Change in CD4 Lymphocyte Count and Weight among HIV Infected Patients on Anti-Retroviral Treatment in Ethiopia: A Retrospective Longitudinal Study

et al. 2013

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BackgroundAntiretroviral treatment (ART) has been introduced in Ethiopia a decade ago and continues to be scaled up. However, there is dearth of literature on the impact of ART on changes in CD4 lymphocyte count and weight among patients on treatment.ObjectiveTo determine the predictors of change in CD4 lymphocyte count and weight among HIV/AIDS infected patients taking antiretroviral treatment in eastern Ethiopia.MethodsA retrospective cohort study was conducted among HIV/AIDS patients taking ART from 2005 to 2010. A sample of 1540 HIV infected adult patients who started antiretroviral therapy in hospitals located in eastern Ethiopia were included in the study. The primary outcomes of interest were changes in CD4 count and weight. Descriptive statistics and multivariable regression analyses were performed to examine the outcomes among the cohort.ResultsBoth the median CD4 lymphocyte counts and weight showed improvements in the follow up periods. The multivariate analysis shows that the duration of ART was an important predictor of improvements in CD4 lymphocyte count (beta 7.91; 95% CI 7.48–8.34; p 0.000) and weight (beta 0.15; 95% CI 0.13–0.18; p 0.000). Advanced WHO clinical stage, lower baseline CD4 cell count, and baseline hemoglobin levels were factors associated with decline in weight. Actively working patients had higher CD4 lymphocyte count and weight compared to those that were ambulatory (p<0.05).ConclusionWe detected a substantial increment in weight and CD4 lymphocyte count among the patients who were taking ART in eastern Ethiopia. Patients who are of older age, with low initial CD4 lymphocyte count, late stage of the WHO clinical stages and lower hemoglobin level may need special attention. The reasons for the improved findings on CD4 count and weight throughout the five years of follow up merit further investigation.

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“…This depletion impairs the immune system and, because of lack of proper immune defense, any opportunistic infection could become fatal to the host. Fortunately, present anti-HIV therapy, namely highly active antiretroviral therapy (HAART) or combination antiretroviral therapy (cART), proved to be successful in controlling HIV infection and significantly prolongs the lifespan of infected individuals (3,4). Sadly, antiretroviral drugs are still not available to every infected patient in developing countries, but more and more programs have been introduced in recent years to make sure that no HIV infection goes without treatment.…”

Section: Introductionmentioning

confidence: 99%