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dc.contributor.authorLodi, Sara 
dc.contributor.authorPhillips, Andrew
dc.contributor.authorFidler, Sarah
dc.contributor.authorHawkins, David
dc.contributor.authorGilson, Richard
dc.contributor.authorMcLean, Ken
dc.contributor.authorFisher, Martin
dc.contributor.authorPost, Frank
dc.contributor.authorJohnson, Anne M
dc.contributor.authorWalker-Nthenda, Louise
dc.contributor.authorDunn, David
dc.contributor.authorPorter, Kholoud
dc.identifier.citationPLoS One. 2013 Sep 24;8(9):e75608.es_ES
dc.description.abstractBACKGROUND: The development of HIV drug resistance and subsequent virological failure are often cited as potential disadvantages of early cART initiation. However, their long-term probability is not known, and neither is the role of duration of infection at the time of initiation. METHODS: Patients enrolled in the UK Register of HIV seroconverters were followed-up from cART initiation to last HIV-RNA measurement. Through survival analysis we examined predictors of virologic failure (2HIV-RNA ≥400 c/l while on cART) including CD4 count and HIV duration at initiation. We also estimated the cumulative probabilities of failure and drug resistance (from the available HIV nucleotide sequences) for early initiators (cART within 12 months of seroconversion). RESULTS: Of 1075 starting cART at a median (IQR) CD4 count 272 (190,370) cells/mm(3) and HIV duration 3 (1,6) years, virological failure occurred in 163 (15%). Higher CD4 count at initiation, but not HIV infection duration at cART initiation, was independently associated with lower risk of failure (p=0.033 and 0.592 respectively). Among 230 patients initiating cART early, 97 (42%) discontinued it after a median of 7 months; cumulative probabilities of resistance and failure by 8 years were 7% (95% CI 4,11) and 19% (13,25), respectively. CONCLUSION: Although the rate of discontinuation of early cART in our cohort was high, the long-term rate of virological failure was low. Our data do not support early cART initiation being associated with increased risk of failure and drug resistance.es_ES
dc.description.sponsorshipThe UK Register of HIV Seroconversion is funded by the Medical Research Council. 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 manuscriptes_ES
dc.publisherPublic Library of Sciencees_ES
dc.relation.isversionofPublisher's versiones_ES
dc.subject.meshAnti-HIV Agents es_ES
dc.subject.meshAnti-Retroviral Agents es_ES
dc.subject.meshCD4 Lymphocyte Count es_ES
dc.subject.meshCD4-Positive T-Lymphocytes es_ES
dc.subject.meshDrug Resistance, Viral es_ES
dc.subject.meshDrug Therapy, Combination es_ES
dc.subject.meshFemale es_ES
dc.subject.meshHIV es_ES
dc.subject.meshHIV Infections es_ES
dc.subject.meshHIV Seropositivity es_ES
dc.subject.meshHumans es_ES
dc.subject.meshMale es_ES
dc.subject.meshRisk es_ES
dc.subject.meshTreatment Failure es_ES
dc.titleRole of HIV infection duration and CD4 cell level at initiation of combination anti-retroviral therapy on risk of failurees_ES
dc.rights.licenseAtribución 4.0 Internacional*
dc.contributor.funderMedical Research Council (United Kingdom)es_ES
dc.identifier.journalPloS onees_ES
dc.repisalud.centroISCIII::Centro Nacional de Epidemologíaes_ES

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