Risk of progression to AIDS and death in women infected with HIV-1 initiating highly active antiretroviral treatment at different stages of disease

Kathryn Anastos, Yolanda Barrón, Paolo Miotti, Barbara Weiser, Mary Young, Nancy Hessol, Ruth M. Greenblatt, Mardge Cohen, Michael Augenbraun, Alexandra Levine, Alvaro Muñoz

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Abstract

Background: The optimal virologic and immunologic stage at which to initiate antiretroviral therapy in individuals infected with human immunodeficiency virus type 1 (HIV-1) is undefined. Methods: Among 1054 HIV-1-infected women in a prospective cohort study, we determined the time from initiation of highly active antiretroviral treatment (HAART) to acquired immunodeficiency syndrome (AIDS) and death. Results: Median follow-up was 3.4 years. Of 553 women without AIDS at HAART initiation, 62 (11%) developed AIDS. Compared with women with CD4+ cell counts greater than 350/μL at HAART initiation, women with cell counts of 200 to 350/μL and less than 200/μL had relative hazards (RHs) for progression to AIDS of 0.93 (95% confidence interval [CI], 0.46-1.86) and 2.48 (95% CI, 1.39-4.42), respectively. Compared with those with HIV-1 RNA values less than 5000 copies/mL, women with 5000 to 50 000 copies/mL and greater than 50 000 copies/mL had RHs of 1.39 (95% CI, 0.74-2.64) and 2.09 (95% CI, 1.09-3.99), respectively. Among women with AIDS at HAART initiation (n=501), RHs of death were 1.97 (95% CI, 0.84-4.66) and 3.35 (95% CI, 1.59-7.08) with CD4+ cell counts of 200 to 350/μL and less than 200/μL, respectively, relative to those with greater than 350/μL, and 1.90 (95% CI, 0.84-4.30) and 3.70 (95% CI, 1.81-7.54) for those with HIV-1 RNA values of 5000 to 50 000 and greater than 50000 copies/mL, respectively, relative to those with less than 5000 copies/mL. Conclusions: Progression to AIDS and death was predicted by pre-HAART values of less than 200/μL for CD4+ cells and greater than 50 000 HIV-1 RNA copies/mL, indicating that deferral of HAART until the CD4+ cell count is between 350 and 200/μL is a valid strategy in the clinical management of HIV-1 infection.

Original languageEnglish (US)
Pages (from-to)1973-1980
Number of pages8
JournalArchives of Internal Medicine
Volume162
Issue number17
DOIs
StatePublished - Sep 23 2002

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HIV-1
Acquired Immunodeficiency Syndrome
Confidence Intervals
CD4 Lymphocyte Count
RNA
Therapeutics
Virus Diseases
Cohort Studies
Cell Count
Prospective Studies

ASJC Scopus subject areas

  • Internal Medicine

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Risk of progression to AIDS and death in women infected with HIV-1 initiating highly active antiretroviral treatment at different stages of disease. / Anastos, Kathryn; Barrón, Yolanda; Miotti, Paolo; Weiser, Barbara; Young, Mary; Hessol, Nancy; Greenblatt, Ruth M.; Cohen, Mardge; Augenbraun, Michael; Levine, Alexandra; Muñoz, Alvaro.

In: Archives of Internal Medicine, Vol. 162, No. 17, 23.09.2002, p. 1973-1980.

Research output: Contribution to journalArticle

Anastos, K, Barrón, Y, Miotti, P, Weiser, B, Young, M, Hessol, N, Greenblatt, RM, Cohen, M, Augenbraun, M, Levine, A & Muñoz, A 2002, 'Risk of progression to AIDS and death in women infected with HIV-1 initiating highly active antiretroviral treatment at different stages of disease', Archives of Internal Medicine, vol. 162, no. 17, pp. 1973-1980. https://doi.org/10.1001/archinte.162.17.1973
Anastos, Kathryn ; Barrón, Yolanda ; Miotti, Paolo ; Weiser, Barbara ; Young, Mary ; Hessol, Nancy ; Greenblatt, Ruth M. ; Cohen, Mardge ; Augenbraun, Michael ; Levine, Alexandra ; Muñoz, Alvaro. / Risk of progression to AIDS and death in women infected with HIV-1 initiating highly active antiretroviral treatment at different stages of disease. In: Archives of Internal Medicine. 2002 ; Vol. 162, No. 17. pp. 1973-1980.
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abstract = "Background: The optimal virologic and immunologic stage at which to initiate antiretroviral therapy in individuals infected with human immunodeficiency virus type 1 (HIV-1) is undefined. Methods: Among 1054 HIV-1-infected women in a prospective cohort study, we determined the time from initiation of highly active antiretroviral treatment (HAART) to acquired immunodeficiency syndrome (AIDS) and death. Results: Median follow-up was 3.4 years. Of 553 women without AIDS at HAART initiation, 62 (11{\%}) developed AIDS. Compared with women with CD4+ cell counts greater than 350/μL at HAART initiation, women with cell counts of 200 to 350/μL and less than 200/μL had relative hazards (RHs) for progression to AIDS of 0.93 (95{\%} confidence interval [CI], 0.46-1.86) and 2.48 (95{\%} CI, 1.39-4.42), respectively. Compared with those with HIV-1 RNA values less than 5000 copies/mL, women with 5000 to 50 000 copies/mL and greater than 50 000 copies/mL had RHs of 1.39 (95{\%} CI, 0.74-2.64) and 2.09 (95{\%} CI, 1.09-3.99), respectively. Among women with AIDS at HAART initiation (n=501), RHs of death were 1.97 (95{\%} CI, 0.84-4.66) and 3.35 (95{\%} CI, 1.59-7.08) with CD4+ cell counts of 200 to 350/μL and less than 200/μL, respectively, relative to those with greater than 350/μL, and 1.90 (95{\%} CI, 0.84-4.30) and 3.70 (95{\%} CI, 1.81-7.54) for those with HIV-1 RNA values of 5000 to 50 000 and greater than 50000 copies/mL, respectively, relative to those with less than 5000 copies/mL. Conclusions: Progression to AIDS and death was predicted by pre-HAART values of less than 200/μL for CD4+ cells and greater than 50 000 HIV-1 RNA copies/mL, indicating that deferral of HAART until the CD4+ cell count is between 350 and 200/μL is a valid strategy in the clinical management of HIV-1 infection.",
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AU - Barrón, Yolanda

AU - Miotti, Paolo

AU - Weiser, Barbara

AU - Young, Mary

AU - Hessol, Nancy

AU - Greenblatt, Ruth M.

AU - Cohen, Mardge

AU - Augenbraun, Michael

AU - Levine, Alexandra

AU - Muñoz, Alvaro

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N2 - Background: The optimal virologic and immunologic stage at which to initiate antiretroviral therapy in individuals infected with human immunodeficiency virus type 1 (HIV-1) is undefined. Methods: Among 1054 HIV-1-infected women in a prospective cohort study, we determined the time from initiation of highly active antiretroviral treatment (HAART) to acquired immunodeficiency syndrome (AIDS) and death. Results: Median follow-up was 3.4 years. Of 553 women without AIDS at HAART initiation, 62 (11%) developed AIDS. Compared with women with CD4+ cell counts greater than 350/μL at HAART initiation, women with cell counts of 200 to 350/μL and less than 200/μL had relative hazards (RHs) for progression to AIDS of 0.93 (95% confidence interval [CI], 0.46-1.86) and 2.48 (95% CI, 1.39-4.42), respectively. Compared with those with HIV-1 RNA values less than 5000 copies/mL, women with 5000 to 50 000 copies/mL and greater than 50 000 copies/mL had RHs of 1.39 (95% CI, 0.74-2.64) and 2.09 (95% CI, 1.09-3.99), respectively. Among women with AIDS at HAART initiation (n=501), RHs of death were 1.97 (95% CI, 0.84-4.66) and 3.35 (95% CI, 1.59-7.08) with CD4+ cell counts of 200 to 350/μL and less than 200/μL, respectively, relative to those with greater than 350/μL, and 1.90 (95% CI, 0.84-4.30) and 3.70 (95% CI, 1.81-7.54) for those with HIV-1 RNA values of 5000 to 50 000 and greater than 50000 copies/mL, respectively, relative to those with less than 5000 copies/mL. Conclusions: Progression to AIDS and death was predicted by pre-HAART values of less than 200/μL for CD4+ cells and greater than 50 000 HIV-1 RNA copies/mL, indicating that deferral of HAART until the CD4+ cell count is between 350 and 200/μL is a valid strategy in the clinical management of HIV-1 infection.

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