Clinical efficacy of early initiation of HAART in patients with asymptomatic HIV infection and CD4 cell count > 350 × 106/l

@article{Opravil2002ClinicalEO,
  title={Clinical efficacy of early initiation of HAART in patients with asymptomatic HIV infection and CD4 cell count > 350 × 106/l},
  author={Milos Opravil and Bruno Ledergerber and Hansjakob Furrer and Bernard Hirschel and Alexander Imhof and Serge Gallant and Thomas Wagels and Enos Bernasconi and Fabian Meienberg and Martin Rickenbach and Rainer Weber},
  journal={AIDS},
  year={2002},
  volume={16},
  pages={1371-1381}
}
ObjectiveTo evaluate the efficacy of early initiation of highly active antiretroviral therapy (HAART), we compared the clinical course of two nested, matched cohorts within the Swiss HIV Cohort Study. MethodsWe selected all asymptomatic patients who started HAART between 1 January 1996 and 31 December 1999 with a CD4 cell count > 350 × 106/l. We then matched them with asymptomatic participants who were seen at around the same time and who remained untreated during the following 12 months. This… 
Interruption of antiretroviral treatment in HIV-infected patients with preserved immune function is associated with a low rate of clinical progression: a prospective study by AIDS Clinical Trials Group 5170.
TLDR
Disease progression after TI was low in this cohort and a higher nadir in CD4(+) cell count, a lower HIV load before ART, and an HIV load < or =50 copies/mL at the time of TI predicted a longer time to the primary end point.
Initiation of highly active antiretroviral therapy at CD4+ T lymphocyte counts of >350 cells/mm3: disease progression, treatment durability, and drug toxicity.
TLDR
Findings support the recommendation that HAART not be initiated for patients with CD4(+) T lymphocyte counts of >350 cells/mm(3) with progression in 174 HIV-infected patients for whom it was not.
Mortality in Patients With Successful Initial Response to Highly Active Antiretroviral Therapy Is Still Higher Than in Non-HIV-Infected Individuals
TLDR
Mortality in HIV-infected patients with a good initial response to HAART is still higher than in the general population, despite the introduction of highly active antiretroviral therapy.
Immunological and Virological Outcomes at 5 Years in HIV Infected Adults Who Start HAART at a CD4 Cell Count of Less Than 200 in Barbados
TLDR
In this relatively small cohort of treatment naive patients presenting late in the course of HIV disease, there was good immunological and virological response after 5 years of initiating HAART irrespective of their baseline CD4+ counts and viral load, age or gender.
When to begin highly active antiretroviral therapy? Evidence supporting initiation of therapy at CD4+ lymphocyte counts <350 cells/microL.
  • J. Kaplan, D. Hanson, M. Dworkin
  • Biology, Medicine
    Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
  • 2003
TLDR
The increased hazard associated with CD4+ cell counts of 200-349 cells/microL was modest but supports initiation of HAART at CD4- cell counts <350 cells/ microL, particularly in patients with high virus loads.
Comparing costs and effectiveness of different starting points for highly active antiretroviral therapy in HIV-positive patients
TLDR
Although immediate HAART initiation did not affect incidence AIDS and death at high CD4 levels, starting HAART with 200–349 CD4 cells/mm3 rather than deferring it below 200 CD4 cellular counts, proved to be cost-effective.
Effect of early versus deferred antiretroviral therapy for HIV on survival.
TLDR
The early initiation of antiretroviral therapy before the CD4+ count fell below two prespecified thresholds significantly improved survival, as compared with deferred therapy.
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
TLDR
The results gave a strong hint for a therapy initiation at higher CD4-cell-count/μl regarding the outcome of death in treated patients, and a distinct benefit was shown regarding the first decline of CD4–μl below 200.
Mortality in HIV-seropositive versus -seronegative persons in the era of highly active antiretroviral therapy: implications for when to initiate therapy.
TLDR
In HIV-seropositive participants, HAART significantly improved survival when initiated at CD4 cell counts < 200 cells/microL, which is higher than is currently recommended.
Survival Benefit of Initiating Antiretroviral Therapy in HIV-Infected Persons in Different CD4+ Cell Strata
TLDR
This cohort study compares mortality rates among ambulatory HIV-infected patients who initiated ART and those who delayed ART in various CD4+ strata and defines HAART as the use of at least three drugs simultaneously.
...
1
2
3
4
5
...

References

SHOWING 1-10 OF 55 REFERENCES
Are HIV-infected patients with rapid CD4 cell decline a subgroup who benefit from early antiretroviral therapy?
TLDR
It is found that a more rapid rate of CD4 decline before randomization was associated with a greater reduction in the rate ofCD4 decline following IMM antiretroviral therapy, and this effect was statistically significant in only the Concorde trial.
Rates of disease progression by baseline CD4 cell count and viral load after initiating triple-drug therapy.
TLDR
The data demonstrate uniformly low rates of disease progression to death and AIDS or death among patients starting antiretroviral therapy with CD4 cell counts of at least 200/microL, as well as a prior diagnosis of acquired immunodeficiency syndrome (AIDS).
Immunological and virological responses in HIV-1-infected adults at early stage of established infection treated with highly active antiretroviral therapy
TLDR
The initiation of HAART at an early stage of established HIV infection induces systemic quantitative normalization of CD4 T cells, a partial recovery of HIV-specific CD4 cell responses, and effective and durable suppression of virus replication.
Relations among CD4 Lymphocyte Count Nadir, Antiretroviral Therapy, and HIV-1 Disease Progression: Results from the EuroSIDA Study
TLDR
The relations among CD4 lymphocyte count, antiretroviral treatment, and clinical disease progression are explored through an analysis of the EuroSIDA cohort study, which follows 7333 European patients infected with HIV-1.
Effects of Early Antiretroviral Treatment on HIV‐1 RNA in Blood and Lymphoid Tissue: A Randomized Trial of Double Versus Triple Therapy
TLDR
Even if treatment is initiated early in asymptomatic patients with preserved CD4 counts, three drugs are necessary to achieve sustained decreases of HIV load in blood and lymphoid tissue.
A comparison of immediate with deferred zidovudine therapy for asymptomatic HIV-infected adults with CD4 cell counts of 500 or more per cubic millimeter. AIDS Clinical Trials Group.
TLDR
In asymptomatic, HIV-infected adults with 500 or more CD4 cells per cubic millimeter, treatment with zidovudine slows the decline in the CD4 cell count but does not significantly prolong either AIDS-free or overall survival.
Simplification with abacavir-based triple nucleoside therapy versus continued protease inhibitor-based highly active antiretroviral therapy in HIV-1-infected patients with undetectable plasma HIV-1 RNA
TLDR
The replacement of PI by abacavir in a triple combination regimen following prolonged suppression of plasma HIV-1 RNA provides continued virological suppression, significant improvements in lipid abnormalities and enhanced ease of dosing.
AIDS-related opportunistic illnesses occurring after initiation of potent antiretroviral therapy: the Swiss HIV Cohort Study.
TLDR
The data indicate that the risk of developing an OI for a person receiving potent antiretroviral therapy is highest during the initial months of therapy, and baseline CD4 cell count and immunologic and virologic response to treatment were strong predictors of disease progression in patients receiving potent therapy.
Immunological benefits of antiretroviral therapy in very early stages of asymptomatic chronic HIV-1 infection
TLDR
Initiating highly active antiretroviral therapy at very early stages of chronic HIV-1 infection allows rapid and almost complete normalization of T cell subsets and preservation of Tcell functions.
...
1
2
3
4
5
...