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

Research output: Contribution to journalArticle

13 Citations (Scopus)

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

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Acquired Immunodeficiency Syndrome
Cohort Studies
HIV
Survival
non-Hodgkin lymphoma
Non-Hodgkin's Lymphoma
Therapeutics
Hazards
Opportunistic Infections
Kaplan-Meier Estimate
disease course
Disease Progression
confidence interval
Confidence Intervals
death
infection
methodology

ASJC Scopus subject areas

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

Cite this

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

In: PLoS One, Vol. 6, No. 10, e26009, 17.10.2011.

Research output: Contribution to journalArticle

Miro, Jose M. ; Manzardo, Christian ; Mussini, Cristina ; Johnson, Margaret ; d'Arminio Monforte, Antonella ; Antinori, Andrea ; Gill, M. John ; Sighinolfi, Laura ; Uberti-Foppa, Caterina ; Borghi, Vanni ; Sabin, Caroline. / 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. In: PLoS One. 2011 ; Vol. 6, No. 10.
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