When to start highly active antiretroviral therapy in chronically HIV-infected patients: evidence from the ICONA study

被引:76
作者
Lepri, AC
Phillips, AN
Monforte, AD
Castelli, F
Antinori, A
de Luca, A
Pezzotti, P
Alberici, F
Cargnel, A
Grima, P
Piscopo, R
Prestileo, T
Scalise, G
Vigevani, M
Moroni, M
机构
[1] UCL Royal Free & Univ Coll Med Sch, Royal Free Ctr HIV Med, London NW3 2PF, England
[2] UCL Royal Free & Univ Coll Med Sch, Dept Primary Care & Populat Sci, London NW3 2PF, England
[3] Univ Milan, Inst Infect & Trop Dis, I-20122 Milan, Italy
[4] Univ Brescia, Clin Infect & Trop Dis, I-25121 Brescia, Italy
[5] IRCCS L Spallanzani, Rome, Italy
[6] Univ Cattolica Sacro Cuore, Dept Infect Dis, Rome, Italy
[7] Ist Super Sanita, Ctr Operat AIDS, I-00161 Rome, Italy
[8] Piacenza Hosp, Dept Infect Dis, Piacenza, Italy
[9] Sacco Hosp, Dept Infect Dis, Milan, Italy
[10] Lecce Hosp, Dept Infect Dis, Lecce, Italy
[11] Galliera Hosp, Dept Infect Dis, Genoa, Italy
[12] Dept Infect Dis, Palermo, Italy
[13] Univ Ancona, Dept Infect Dis, I-60128 Ancona, Italy
[14] St Anna Hosp, Dept Infect Dis, Como, Italy
关键词
highly active antiretroviral therapy; virological response; immunological response; CD4 cell count;
D O I
10.1097/00002030-200105250-00006
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Objectives: To compare the response to highly active antiretroviral therapy (HAART) in individuals starting HAART at different CD4 cell counts. Design: The mean increase in CD4 cell count and rate of virological failure after commencing HAARTwere measured in antiretroviral-naive patients(1421) in a large, nonrandomized multicentre, observational study in Italy (ICONA). Clinical endpoints were a Iso evaluated in a subset of patients who started HAARTwith a very low CD4 cell count. Results: After 96 weeks of therapy, the mean rise in CD4 cell count was 280, 281 and 186 x 10(6) cells/l in patients starting HAART with a CD4 cell count < 200, 201-350 and > 350 x 10(6) cells/l, respectively. Patients starting HAART with a CD4 cell count < 200 x 10(6) cells/l tended to have a higher risk of subsequent virological failure [relative hazard (RH), 1.15; 95% confidence interval (CI), 0.93-1.42] compared with patients starting with > 350 x 10(6) cells/l. There was no difference in risk between the 201-350 and the > 350 x 10(6) cells/l groups (RH, 1.0; 95% CI, 0.79-1.29). The incidence of new AIDS-defining diseases/death in patients who started HAART with a CD4 count < 50 was 0.03/person-year (95% CI, 0.10-0.33) during the time in which the patient's CD4 cell count had been raised to > 200 x 10(6) cells/l. Conclusions: There was no clear immunological or virological advantage in starting HAART at a CD4 cell count > 350 rather than at 200-350 x 10(6) cells/l. The increase in CD4 cells restored by HAART is meaningful in that they are associated with reduced risk of disease/death. (C) 2001 Lippincott Williams & Wilkins.
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页码:983 / 990
页数:8
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