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Title: Survival outcomes and effect of early vs. deferred cART among HIV-infected patients diagnosed at the time of an AIDS-defining event: a cohort analysis.
Author: Miró Meda, José M.
Manzardo, Christian
Mussini, Cristina
Johnson, Margaret M.
D'Arminio Monforte, Antonella
Antinori, Antonella
Gill, M. John
Sighinolfi, Laura
Uberti-Foppa, Caterina
Borghi, Vanni
Sabin, Caroline
Late Presenters Investigators.
Keywords: VIH (Virus)
Persones seropositives
HIV (Viruses)
AIDS (Disease)
Antiretroviral agents
HIV-positive persons
Issue Date: 17-Oct-2011
Publisher: Public Library of Science (PLoS)
Abstract: Objectives: We analyzed clinical progression among persons diagnosed with HIV at the time of an AIDS-defining event, and assessed the impact on outcome of timing of combined antiretroviral treatment (cART). Methods: Retrospective, European and Canadian multicohort study.. Patients were diagnosed with HIV from 1997-2004 and had clinical AIDS from 30 days before to 14 days after diagnosis. Clinical progression (new AIDS event, death) was described using Kaplan-Meier analysis stratifying by type of AIDS event. Factors associated with progression were identified with multivariable Cox regression. Progression rates were compared between those starting early (< 30 days after AIDS event) or deferred (30-270 days after AIDS event) cART. Results: The median (interquartile range) CD4 count and viral load (VL) at diagnosis of the 584 patients were 42 (16, 119) cells/ mL and 5.2 (4.5, 5.7) log 10 copies/mL. Clinical progression was observed in 165 (28.3%) patients. Older age, a higher VL at diagnosis, and a diagnosis of non-Hodgkin lymphoma (NHL) (vs. other AIDS events) were independently associated with disease progression. Of 366 patients with an opportunistic infection, 178 (48.6%) received early cART. There was no significant difference in clinical progression between those initiating cART early and those deferring treatment (adjusted hazard ratio 1.32 [95% confidence interval 0.87, 2.00], p=0.20). Conclusions: Older patients and patients with high VL or NHL at diagnosis had a worse outcome. Our data suggest that earlier initiation of cART may be beneficial among HIV-infected patients diagnosed with clinical AIDS in our setting.
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It is part of: PLoS One, 2011, vol. 6, num. 10, p. e26009
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ISSN: 1932-6203
Appears in Collections:Articles publicats en revistes (Medicina)

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