TITLE

Age at Entry Into Care, Timing of Antiretroviral Therapy Initiation, and 10-Year Mortality Among HIV-Seropositive Adults in the United States

AUTHOR(S)
Edwards, Jessie K.; Cole, Stephen R.; Westreich, Daniel; Mugavero, Michael J.; Eron, Joseph J.; Moore, Richard D.; Mathews, William C.; Hunt, Peter; Williams, Carolyn
PUB. DATE
October 2015
SOURCE
Clinical Infectious Diseases;10/1/2015, Vol. 61 Issue 7, p1189
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Background. The goal of targeted antiretroviral therapy initiation is to minimize disease progression among patients with human immunodeficiency virus while minimizing the therapeutic burden on these patients. We examine whether the effect of delaying therapy initiation from 500 cells/mm³ to 350 or 200 cells/mm³ is modified by age at entry into care. Methods. We used the parametric g-formula to compare 10-year mortality under 3 CD4 cell count thresholds for therapy initiation among 3532 patients who entered care at 1 of 8 sites in the United States between 1998 and 2013. Results are reported separately for patients 18 to 34, 35 to 44, and 45 to 65 years of age at study entry. Results. In the observed data, 10-year mortality was 13% (165 deaths). Mortality increased from 11% under therapy initiation at 500 cells/mm3 to 12% at 350 cells/mm3 (risk difference [RD]: 0.87; 95% confidence interval [CI]: .56, 2.17) and to 14% at 200 cells/mm3 (RD: 2.71; 95% CI: 1.79, 5.38). The effect of delaying therapy became greater with age: RDs comparing the 350-cells/mm3 threshold with the 500-cells/mm3 threshold ranged from -0.03 (95% CI: -0.15, 1.76) for patients 18 to 34 years of age to 0.99 (95% CI: -.27, 1.98) for patients 35 to 44 and to 2.30 (95% CI: 1.29, 5.42) for patients 45 to 65. Conclusions. Delaying therapy increased 10-year mortality in the full cohort. Subgroup analysis highlights that patients entering care at older ages may be more vulnerable to the consequences of delayed ART initiation than younger patients.
ACCESSION #
109481977

 

Related Articles

  • Trends in Antiretroviral Drug Use During Pregnancy Among HIV-Infected Women on Medicaid: 2000-2007. Phiri, Kelesitse; Fischer, Michael A.; Mogun, Helen; Williams, Paige L.; Palmsten, Kristin; Seage, George R.; Hernandez-Diaz, Sonia // AIDS Patient Care & STDs;Feb2014, Vol. 28 Issue 2, p56 

    Optimal use of antiretroviral drugs by pregnant women living with human immunodeficiency virus (HIV) is crucial to treat maternal HIV infection and prevent perinatal transmission of the virus effectively. Our goal was to describe national trends of antiretroviral (ARV) use during pregnancy among...

  • Entry Into Care and Clinician Management of Acute HIV Infection in New York City. Sabharwal, Charulata J.; Bodach, Sara; Braunstein, Sarah L.; Sepkowitz, Kent; Shepard, Colin // AIDS Patient Care & STDs;Mar2012, Vol. 26 Issue 3, p129 

    A letter to the editor is presented in which the authors discuss, their study focused on entry into care and clinician management of acute HIV Infection (AHI), and the need to reconsider current restrictions on the use of the HIV registry for clinical purposes.

  • Cost-Effectiveness of Early Infant HIV Diagnosis of HIV-Exposed Infants and Immediate Antiretroviral Therapy in HIV-Infected Children under 24 Months in Thailand. Collins, Intira Jeannie; Cairns, John; Ngo-Giang-Huong, Nicole; Sirirungsi, Wasna; Leechanachai, Pranee; Le Coeur, Sophie; Samleerat, Tanawan; Kamonpakorn, Nareerat; Mekmullica, Jutarat; Jourdain, Gonzague; Lallemant, Marc // PLoS ONE;Mar2014, Vol. 9 Issue 3, p1 

    Background: HIV-infected infants have high risk of death in the first two years of life if untreated. WHO guidelines recommend early infant HIV diagnosis (EID) of all HIV-exposed infants and immediate antiretroviral therapy (ART) in HIV-infected children under 24-months. We assessed the...

  • Safety Considerations in Drug Treatment of Depression in HIV-Positive Patients. Watkins, Crystal C.; Pieper, Andrew A.; Treisman, Glenn J. // Drug Safety;2011, Vol. 34 Issue 8, p623 

    Major depressive disorder (MDD) is one of the most prevalent illnesses associated with HIV infection, and negatively affects medication adherence, disease progression and mortality in HIV disease. Co-morbid treatment of major depression in HIV disease is the optimal therapeutic approach, but...

  • Distribution of Candida species among HIV-positive patients with oropharyngeal candidiasis in Accra, Ghana. Kwamin, Francis; Otu Nartey, Nii; Codjoe, Francis S.; Newman, Mercy J. // Journal of Infection in Developing Countries;Jan2013, Vol. 7 Issue 1, p41 

    Introduction: Oropharyngeal candidiasis is a common occurrence in the course of human immunodeficiency virus (HIV) disease progression. Changes in the clinical severity of oropharyngeal candidiasis and type of Candida species profile may be a reflection of immunological changes in patients. The...

  • HIV-1 Group O Origin, Evolution, Pathogenesis, and Treatment: Unraveling the Complexity of an Outlier 25 Years Later. Bush, Shannon; Tebit, Denis M. // AIDS Reviews;Jul-Sep2015, Vol. 17 Issue 3, p147 

    Twenty-five years ago, an aberrant HIV-1 (now classified as HIV-1 group O) was described from a Cameroonian HIV patient living in Belgium. The epicenter of group O was later found to be in Central Africa, overlapping with the geographical location of the central chimpanzees (Pan troglodytes...

  • Adherence to Antiretroviral Therapy and Its Effect on Survival of HIV-Infected Individuals in Jharkhand, India. Rai, Sandeep; Mahapatra, Bidhubhusan; Sircar, Subhashish; Raj, Pinnamaneni Yujwal; Venkatesh, Srinivasan; Shaukat, Mohammed; Rewari, Bharat Bhusan // PLoS ONE;Jun2013, Vol. 8 Issue 6, p1 

    Introduction: Research in India has extensively examined the factors associated with non-adherence to antiretroviral therapy (ART) with limited focus on examining the relationship between adherence to ART regimen and survival status of HIV infected patients. This study examines the effect of...

  • AIDS deaths down, cancer deaths up in large US/European HIV group.  // HIV Treatment ALERTS!;Nov2014, p16 

    The article reports on a study which reveals that AIDS-related deaths have decreased, while deaths due to cancer have increased in large HIV group in the U.S. and Europe. The falling death rate among HIV-positive people is attributed to antiretroviral therapy. It implies that higher death rate...

  • Liver and heart deaths down in Europe/US HIV study, but not non-AIDS cancers.  // HIV Treatment ALERTS!;Nov2014, p21 

    The article reports on a study which reveals that liver and heart-related deaths have decreased, while deaths due to cancer have increased in large HIV group in the U.S. and Europe. The falling death rate among HIV-positive people is attributed to antiretroviral therapy. It also implies that...

Share

Read the Article

Courtesy of THE LIBRARY OF VIRGINIA

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics