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dc.contributor.authorLodi, Sara 
dc.contributor.authorFisher, Martin
dc.contributor.authorPhillips, Andrew
dc.contributor.authorDe Luca, Andrea
dc.contributor.authorGhosn, Jade
dc.contributor.authorMalyuta, Ruslan
dc.contributor.authorZangerle, Robert
dc.contributor.authorMoreno, Santiago
dc.contributor.authorVanhems, Philippe
dc.contributor.authorBoufassa, Faroudy
dc.contributor.authorGuiguet, Marguerite
dc.contributor.authorPorter, Kholoud
dc.identifier.citationPLoS One. 2013 Nov 14;8(11):e78642.es_ES
dc.description.abstractBACKGROUND: The risk/benefit of initiating ART in primary HIV infection (PHI) is unclear. The benefits are more likely to outweigh the risks in patients with severe PHI. An accepted definition of severe PHI is, however, lacking. METHODS: CASCADE patients with HIV test interval <6 months were classified as severe and non-severe PHI based on whether the following traits were recorded in the first 6 months following seroconversion: severe specific pre-defined symptoms, central nervous system-implicated illness, and ≥1, ≥2 CD4<350 (and <500) cells/mm(3). For each definition, we used Kaplan-Meier curves and Cox survival models to compare time to AIDS/death, censoring at the earlier of last clinic visit or 1/1/1997, when combination antiretroviral therapy (cART) became available. RESULTS: Among 1108 included patients mostly males (85%) infected through sex between men (71%), 366 were diagnosed with AIDS/died. The risk of AIDS/death was significantly higher for individuals with severe symptoms, those with ≥1 CD4<350 cells/mm(3) or ≥2 CD4 <500 cells/mm(3) in the first 6 months [aHR (95% confidence interval) 2.1 (1.4,3.2), 2.0 (1.5,2.7), and 2.3, (1.5-3.5) respectively]. Median [interquantile range] survival for patients with ≥2, ≥1 and no CD4<350 cells/mm(3) within 6 months of seroconversion was 3.9 [2.7,6.5], 5.4 [4.5,8.4] and 8.1 [4.3,10.3] years, respectively. The diagnosis of CNS-implicated symptoms was rare and did not appear to be prognostic. CONCLUSION: One CD4 count <350 or two <500 cells/mm(3) within 6 months of seroconversion and/or severe illness in PHI may be useful early indicators of individuals at high risk of disease progression.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 no. 260694. Sara Lodi is holder of a Juan de la Cierva Fellowship (grant number JCI 2010-08151). There are no current external funding sources for this study. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.es_ES
dc.publisherPublic Library of Sciencees_ES
dc.subject.meshBiomarkers es_ES
dc.subject.meshCD4 Lymphocyte Count es_ES
dc.subject.meshDisease-Free Survival es_ES
dc.subject.meshFemale es_ES
dc.subject.meshHIV Seropositivity es_ES
dc.subject.meshHumans es_ES
dc.subject.meshMale es_ES
dc.subject.meshSurvival Rate es_ES
dc.subject.meshHIV-1 es_ES
dc.subject.meshModels, Biological es_ES
dc.subject.meshSeverity of Illness Index es_ES
dc.titleSymptomatic illness and low CD4 cell count at HIV seroconversion as markers of severe primary HIV infectiones_ES
dc.typejournal articlees_ES
dc.rights.licenseAtribución 4.0 Internacional*
dc.contributor.funderEuropean Union
dc.identifier.journalPloS onees_ES
dc.repisalud.centroISCIII::Centro Nacional de Epidemologíaes_ES
dc.relation.projectIDinfo:eu-repo/grantAgreement/ES/JCI 2010-08151es_ES
dc.rights.accessRightsopen accesses_ES

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