Long-term increase in CD4+ T-cell counts during combination antiretroviral therapy for HIV-1 infection
OBJECTIVE: To inform guidelines concerning when to initiate combination antiretroviral therapy (ART), we investigated whether CD4(+) T-cell counts (CD4 cell counts) continue to increase over long periods of time on ART. Losses-to-follow-up and some patients discontinuing ART at higher CD4 cell counts hamper such evaluation, but novel statistical methods can help address these issues. We estimated the long-term CD4 cell count trajectory accounting for losses-to-follow-up and treatment discontinuations.
DESIGN: The study population included 898 US patients first initiating ART in a randomized trial (AIDS Clinical Trials Group 384); 575 were subsequently prospectively followed in an observational study (AIDS Clinical Trials Group Longitudinal Linked Randomized Trials).
METHODS: Inverse probability of censoring weighting statistical methods were used to estimate the CD4 cell count trajectory accounting for losses-to-follow-up and ART discontinuations, overall and for pretreatment CD4 cell count categories (<or=200, 201-350, 351-500, and >500 cells/microl).
RESULTS: Median CD4 cell count increased from 270 cells/microl pre-ART to an estimated 556 cells/microl at 3 and 532 cells/microl at 7 years after starting ART in analyses ignoring treatment discontinuations, and to 570 and 640 cells/microl, respectively, had all patients continued ART. However, even had ART been continued, an estimated 25, 9, 3, and 2% of patients with pretreatment CD4 cell counts of 200 or less, 201-350, 351-500, and more than 500 cells/microl would have had CD4 cell counts of 350 cells/microl or less after 7 years.
CONCLUSION: If patients remain on ART, CD4 cell counts increase in most patients for at least 7 years. However, the substantial percentage of patients starting therapy at low CD4 cell counts who still had low CD4 cell counts after 7 years provides support for ART initiation at higher CD4 cell counts.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2010 |
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| Erschienen: |
2010 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:24 |
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| Enthalten in: |
AIDS (London, England) - 24(2010), 12 vom: 31. Juli, Seite 1867-76 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Lok, Judith J [VerfasserIn] |
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| Links: |
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| Themen: |
Journal Article |
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| Anmerkungen: |
Date Completed 06.05.2011 Date Revised 20.10.2021 published: Print ClinicalTrials.gov: NCT00000919, NCT00001137 Citation Status MEDLINE |
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| doi: |
10.1097/QAD.0b013e32833adbcf |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM198061021 |
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| 041 | |a eng | ||
| 100 | 1 | |a Lok, Judith J |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Long-term increase in CD4+ T-cell counts during combination antiretroviral therapy for HIV-1 infection |
| 264 | 1 | |c 2010 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
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| 500 | |a Date Completed 06.05.2011 | ||
| 500 | |a Date Revised 20.10.2021 | ||
| 500 | |a published: Print | ||
| 500 | |a ClinicalTrials.gov: NCT00000919, NCT00001137 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a OBJECTIVE: To inform guidelines concerning when to initiate combination antiretroviral therapy (ART), we investigated whether CD4(+) T-cell counts (CD4 cell counts) continue to increase over long periods of time on ART. Losses-to-follow-up and some patients discontinuing ART at higher CD4 cell counts hamper such evaluation, but novel statistical methods can help address these issues. We estimated the long-term CD4 cell count trajectory accounting for losses-to-follow-up and treatment discontinuations | ||
| 520 | |a DESIGN: The study population included 898 US patients first initiating ART in a randomized trial (AIDS Clinical Trials Group 384); 575 were subsequently prospectively followed in an observational study (AIDS Clinical Trials Group Longitudinal Linked Randomized Trials) | ||
| 520 | |a METHODS: Inverse probability of censoring weighting statistical methods were used to estimate the CD4 cell count trajectory accounting for losses-to-follow-up and ART discontinuations, overall and for pretreatment CD4 cell count categories (<or=200, 201-350, 351-500, and >500 cells/microl) | ||
| 520 | |a RESULTS: Median CD4 cell count increased from 270 cells/microl pre-ART to an estimated 556 cells/microl at 3 and 532 cells/microl at 7 years after starting ART in analyses ignoring treatment discontinuations, and to 570 and 640 cells/microl, respectively, had all patients continued ART. However, even had ART been continued, an estimated 25, 9, 3, and 2% of patients with pretreatment CD4 cell counts of 200 or less, 201-350, 351-500, and more than 500 cells/microl would have had CD4 cell counts of 350 cells/microl or less after 7 years | ||
| 520 | |a CONCLUSION: If patients remain on ART, CD4 cell counts increase in most patients for at least 7 years. However, the substantial percentage of patients starting therapy at low CD4 cell counts who still had low CD4 cell counts after 7 years provides support for ART initiation at higher CD4 cell counts | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Multicenter Study | |
| 650 | 4 | |a Randomized Controlled Trial | |
| 650 | 4 | |a Research Support, N.I.H., Extramural | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 700 | 1 | |a Bosch, Ronald J |e verfasserin |4 aut | |
| 700 | 1 | |a Benson, Constance A |e verfasserin |4 aut | |
| 700 | 1 | |a Collier, Ann C |e verfasserin |4 aut | |
| 700 | 1 | |a Robbins, Gregory K |e verfasserin |4 aut | |
| 700 | 1 | |a Shafer, Robert W |e verfasserin |4 aut | |
| 700 | 1 | |a Hughes, Michael D |e verfasserin |4 aut | |
| 700 | 0 | |a ALLRT team |e verfasserin |4 aut | |
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| 700 | 1 | |a Albrecht, Mary |e investigator |4 oth | |
| 700 | 1 | |a Kim, Neah |e investigator |4 oth | |
| 700 | 1 | |a Skolnik, Paul R |e investigator |4 oth | |
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| 700 | 1 | |a Sax, Paul |e investigator |4 oth | |
| 700 | 1 | |a Delaney, Joanne |e investigator |4 oth | |
| 700 | 1 | |a Jones, Denice |e investigator |4 oth | |
| 700 | 1 | |a Wiggins, Ilene |e investigator |4 oth | |
| 700 | 1 | |a Forcht, Janet |e investigator |4 oth | |
| 700 | 1 | |a St Louis, Richardson |e investigator |4 oth | |
| 700 | 1 | |a Valle, Sandra |e investigator |4 oth | |
| 700 | 1 | |a Norris, Jane |e investigator |4 oth | |
| 700 | 1 | |a Currier, Judith |e investigator |4 oth | |
| 700 | 1 | |a Cahill, Susan |e investigator |4 oth | |
| 700 | 1 | |a Meixner, Linda |e investigator |4 oth | |
| 700 | 1 | |a Hare, C Bradley |e investigator |4 oth | |
| 700 | 1 | |a Havlir, Diane |e investigator |4 oth | |
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| 700 | 1 | |a Fischl, Margaret A |e investigator |4 oth | |
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