Survival outcomes and effect of early vs. deferred cART among HIV-infected patients diagnosed at the time of an AIDS-defining event: A cohort analysis

Jose M. Miro, Christian Manzardo, Cristina Mussini, Margaret Johnson, Antonella d'Arminio Monforte, Andrea Antinori, M. John Gill, Laura Sighinolfi, Caterina Uberti-Foppa, Vanni Borghi, Caroline Sabin

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Abstract

Objectives: We analyzed clinical progression among persons diagnosed with HIV at the time of an AIDS-defining event, and assessed the impact on outcome of timing of combined antiretroviral treatment (cART). Methods: Retrospective, European and Canadian multicohort study.. Patients were diagnosed with HIV from 1997-2004 and had clinical AIDS from 30 days before to 14 days after diagnosis. Clinical progression (new AIDS event, death) was described using Kaplan-Meier analysis stratifying by type of AIDS event. Factors associated with progression were identified with multivariable Cox regression. Progression rates were compared between those starting early (10 copies/mL. Clinical progression was observed in 165 (28.3%) patients. Older age, a higher VL at diagnosis, and a diagnosis of non-Hodgkin lymphoma (NHL) (vs. other AIDS events) were independently associated with disease progression. Of 366 patients with an opportunistic infection, 178 (48.6%) received early cART. There was no significant difference in clinical progression between those initiating cART early and those deferring treatment (adjusted hazard ratio 1.32 [95% confidence interval 0.87, 2.00], p = 0.20). Conclusions: Older patients and patients with high VL or NHL at diagnosis had a worse outcome. Our data suggest that earlier initiation of cART may be beneficial among HIV-infected patients diagnosed with clinical AIDS in our setting.

Original languageEnglish
Article numbere26009
JournalPLoS One
Volume6
Issue number10
DOIs
Publication statusPublished - Oct 17 2011

ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

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    Miro, J. M., Manzardo, C., Mussini, C., Johnson, M., d'Arminio Monforte, A., Antinori, A., Gill, M. J., Sighinolfi, L., Uberti-Foppa, C., Borghi, V., & Sabin, C. (2011). Survival outcomes and effect of early vs. deferred cART among HIV-infected patients diagnosed at the time of an AIDS-defining event: A cohort analysis. PLoS One, 6(10), [e26009]. https://doi.org/10.1371/journal.pone.0026009