Show simple item record

dc.contributor.authorOlson, Ashley D
dc.contributor.authorWalker, A Sarah
dc.contributor.authorSuthar, Amitabh B
dc.contributor.authorSabin, Caroline
dc.contributor.authorBucher, Heiner C
dc.contributor.authorJarrin-Vera, Inmaculada 
dc.contributor.authorMoreno, Santiago
dc.contributor.authorPerez-Hoyos, Santiago
dc.contributor.authorPorter, Kholoud
dc.contributor.authorFord, Deborah
dc.identifier.citationJ Acquir Immune Defic Syndr. 2016 Sep 1;73(1):100-8.es_ES
dc.description.abstractBACKGROUND: Viremia copy-years (VCY), a time-updated measure of cumulative HIV exposure, predicts AIDS/death; although its utility in deciding when to start combination antiretroviral therapy (cART) remains unclear. We aimed to assess the impact of initiating versus deferring cART on risk of AIDS/death by levels of VCY both independent of and within CD4 cell count strata ≥500 cells per cubic millimeter. METHODS: Using Concerted Action on Seroconversion to AIDS and Death in Europe (CASCADE) data, we created a series of nested "trials" corresponding to consecutive months for individuals ≥16 years at seroconversion after 1995 who were cART-naive and AIDS-free. Pooling across all trials, time to AIDS/death by CD4, and VCY strata was compared in those initiating vs. deferring cART using Cox models adjusted for: country, sex, risk group, seroconversion year, age, time since last HIV-RNA, and current CD4, VCY, HIV-RNA, and mean number of previous CD4/HIV-RNA measurements/year. RESULTS: Of 9353 individuals, 5312 (57%) initiated cART and 486 (5%) acquired AIDS/died. Pooling CD4 strata, risk of AIDS/death associated with initiating vs. deferring cART reduced as VCY increased. In patients with high CD4 cell counts, ≥500 cells per cubic millimeter, there was a trend for a greater reduction for those initiating vs. deferring with increasing VCY (P = 0.09), with the largest benefit in the VCY ≥100,000 copy-years/mL group [hazard ratio (95% CI) = 0.41 (0.19 to 0.87)]. CONCLUSIONS: For individuals with CD4 ≥500 cells per cubic millimeter, limiting the cumulative HIV burden to <100,000 copy-years/mL through cART may reduce the risk of AIDS/death.es_ES
dc.description.sponsorshipThe research leading to these results has received funding from the European Union Seventh Framework Programme (FP7/2007-2013) under EuroCoord grant agreement n° 260694 and Medical Research Council UK.es_ES
dc.publisherLippincott, Williams & Wilkinses_ES
dc.relation.isversionofPublisher's versiones_ES
dc.subject.meshAcquired Immunodeficiency Syndrome es_ES
dc.subject.meshAdolescent es_ES
dc.subject.meshAdult es_ES
dc.subject.meshCD4 Lymphocyte Count es_ES
dc.subject.meshFemale es_ES
dc.subject.meshHIV Infections es_ES
dc.subject.meshHumans es_ES
dc.subject.meshMale es_ES
dc.subject.meshMiddle Aged es_ES
dc.subject.meshViremia es_ES
dc.subject.meshYoung Adult es_ES
dc.titleLimiting Cumulative HIV Viremia Copy-Years by Early Treatment Reduces Risk of AIDS and Deathes_ES
dc.rights.licenseAtribución-NoComercial- 4.0 Internacional*
dc.contributor.funder7º Programa Marco-Comisión Europea
dc.contributor.funderMedical Research Council (United Kingdom)
dc.identifier.journalJournal of acquired immune deficiency syndromes (1999)es_ES
dc.repisalud.centroISCIII::Centro Nacional de Epidemologíaes_ES

Files in this item

Acceso Abierto

This item appears in the following Collection(s)

Show simple item record

Atribución-NoComercial- 4.0 Internacional
This item is licensed under a: Atribución-NoComercial- 4.0 Internacional