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<publisher>HAL CCSD</publisher>
<title lang=en>When to initiate combined antiretroviral therapy to reduce mortality and AIDS-defining illness in HIV-infected persons in developed countries: an observational study.</title>
<creator>Cain, Lauren E</creator>
<creator>Logan, Roger</creator>
<creator>Robins, James M</creator>
<creator>Sterne, Jonathan A C</creator>
<creator>Sabin, Caroline</creator>
<creator>Bansi, Loveleen</creator>
<creator>Justice, Amy</creator>
<creator>Goulet, Joseph</creator>
<creator>Van Sighem, Ard</creator>
<creator>De Wolf, Frank</creator>
<creator>Bucher, Heiner C</creator>
<creator>Von Wyl, Viktor</creator>
<creator>Esteve, Anna</creator>
<creator>Casabona, Jordi</creator>
<creator>Del Amo, Julia</creator>
<creator>Moreno, Santiago</creator>
<creator>Seng, Remonie</creator>
<creator>Meyer, Laurence</creator>
<creator>Perez-Hoyos, Santiago</creator>
<creator>Muga, Roberto</creator>
<creator>Lodi, Sara</creator>
<creator>Lanoy, Emilie</creator>
<creator>Costagliola, Dominique</creator>
<creator>Hernan, Miguel A</creator>
<creator>Michelet, Christian</creator>
<contributor>Department of Epidemiology ; Harvard School of Public Health</contributor>
<contributor>Research Department of Infection and Population Health [London] ; University College of London [London] (UCL)</contributor>
<contributor>Centre for Epidemiological Studies on HIV/AIDS and STI of Catalonia (CEEISCAT) ; Centre for Epidemiological Studies on HIV/AIDS and STI of Catalonia (CEEISCAT)</contributor>
<contributor>Centre de recherche en épidémiologie et santé des populations (CESP) ; Université de Versailles Saint-Quentin-en-Yvelines (UVSQ) - Université Paris-Sud - Paris 11 (UP11) - Assistance publique - Hôpitaux de Paris (AP-HP) - Hôpital Paul Brousse - Institut National de la Santé et de la Recherche Médicale (INSERM)</contributor>
<contributor>Departamento de Fisica Aplicada [Bilbao] ; Universidad del Pais Vasco / Euskal Herriko Unibertsitatea (UPV/EHU)</contributor>
<contributor>Epidémiologie, stratégies thérapeutiques et virologie cliniques dans l'infection à VIH ; Université Pierre et Marie Curie - Paris 6 (UPMC) - Institut National de la Santé et de la Recherche Médicale (INSERM)</contributor>
<contributor>Institut de recherche, santé, environnement et travail [Rennes] (Irset) ; Université d'Angers (UA) - Université des Antilles et de la Guyane (UAG) - Université de Rennes 1 (UR1) - École des Hautes Études en Santé Publique [EHESP] (EHESP) - Institut National de la Santé et de la Recherche Médicale (INSERM) - Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique )</contributor>
<contributor>National Institutes of Health (grants R01-AI073127 and U10-AA013566); the Medical Research Council (grant G0700820).</contributor>
<description>International audience</description>
<source>ISSN: 0003-4819</source>
<source>EISSN: 1539-3704</source>
<source>Annals of Internal Medicine</source>
<publisher>American College of Physicians</publisher>
<identifier>hal-00875307</identifier>
<identifier>https://hal.archives-ouvertes.fr/hal-00875307</identifier>
<source>https://hal.archives-ouvertes.fr/hal-00875307</source>
<source>Annals of Internal Medicine, American College of Physicians, 2011, 154 (8), pp.509-15. 〈10.7326/0003-4819-154-8-201104190-00001〉</source>
<identifier>PUBMED : 21502648</identifier>
<relation>info:eu-repo/semantics/altIdentifier/pmid/21502648</relation>
<identifier>DOI : 10.7326/0003-4819-154-8-201104190-00001</identifier>
<relation>info:eu-repo/semantics/altIdentifier/doi/10.7326/0003-4819-154-8-201104190-00001</relation>
<language>en</language>
<subject>[SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases</subject>
<type>info:eu-repo/semantics/article</type>
<type>Journal articles</type>
<description lang=en>BACKGROUND: Most clinical guidelines recommend that AIDS-free, HIV-infected persons with CD4 cell counts below 0.350 × 10(9) cells/L initiate combined antiretroviral therapy (cART), but the optimal CD4 cell count at which cART should be initiated remains a matter of debate. OBJECTIVE: To identify the optimal CD4 cell count at which cART should be initiated. DESIGN: Prospective observational data from the HIV-CAUSAL Collaboration and dynamic marginal structural models were used to compare cART initiation strategies for CD4 thresholds between 0.200 and 0.500 × 10(9) cells/L. SETTING: HIV clinics in Europe and the Veterans Health Administration system in the United States. PATIENTS: 20, 971 HIV-infected, therapy-naive persons with baseline CD4 cell counts at or above 0.500 × 10(9) cells/L and no previous AIDS-defining illnesses, of whom 8392 had a CD4 cell count that decreased into the range of 0.200 to 0.499 × 10(9) cells/L and were included in the analysis. MEASUREMENTS: Hazard ratios and survival proportions for all-cause mortality and a combined end point of AIDS-defining illness or death. RESULTS: Compared with initiating cART at the CD4 cell count threshold of 0.500 × 10(9) cells/L, the mortality hazard ratio was 1.01 (95% CI, 0.84 to 1.22) for the 0.350 threshold and 1.20 (CI, 0.97 to 1.48) for the 0.200 threshold. The corresponding hazard ratios were 1.38 (CI, 1.23 to 1.56) and 1.90 (CI, 1.67 to 2.15), respectively, for the combined end point of AIDS-defining illness or death. Limitations: CD4 cell count at cART initiation was not randomized. Residual confounding may exist. CONCLUSION: Initiation of cART at a threshold CD4 count of 0.500 × 10(9) cells/L increases AIDS-free survival. However, mortality did not vary substantially with the use of CD4 thresholds between 0.300 and 0.500 × 10(9) cells/L.</description>
<contributor>The HIV-CAUSAL Collaboration</contributor>
<date>2011-04-19</date>
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