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      Time to initiation of antiretroviral therapy in HIV-infected patients diagnosed with an opportunistic disease: a cohort study : Determinants and impact of time to ART

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          Abstract

          The aim of the study was to identify factors associated with the time between opportunistic disease (OD) diagnosis and antiretroviral therapy (ART) initiation in HIV-infected patients presenting for care with an OD, and to evaluate the outcomes associated with any delay.

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          Early Antiretroviral Therapy Reduces AIDS Progression/Death in Individuals with Acute Opportunistic Infections: A Multicenter Randomized Strategy Trial

          Andrew Zolopa, Janet Andersen, Lauren Komarow … (2009)
          Background Optimal timing of ART initiation for individuals presenting with AIDS-related OIs has not been defined. Methods and Findings A5164 was a randomized strategy trial of “early ART” - given within 14 days of starting acute OI treatment versus “deferred ART” - given after acute OI treatment is completed. Randomization was stratified by presenting OI and entry CD4 count. The primary week 48 endpoint was 3-level ordered categorical variable: 1. Death/AIDS progression; 2. No progression with incomplete viral suppression (ie HIV viral load (VL) ≥50 copies/ml); 3. No progression with optimal viral suppression (ie HIV VL <50 copies/ml). Secondary endpoints included: AIDS progression/death; plasma HIV RNA and CD4 responses and safety parameters including IRIS. 282 subjects were evaluable; 141 per arm. Entry OIs included Pneumocytis jirovecii pneumonia 63%, cryptococcal meningitis 12%, and bacterial infections 12%. The early and deferred arms started ART a median of 12 and 45 days after start of OI treatment, respectively. The difference in the primary endpoint did not reach statistical significance: AIDS progression/death was seen in 20 (14%) vs. 34 (24%); whereas no progression but with incomplete viral suppression was seen in 54 (38%) vs. 44 (31%); and no progression with optimal viral suppression in 67 (48%) vs 63 (45%) in the early vs. deferred arm, respectively (p = 0.22). However, the early ART arm had fewer AIDS progression/deaths (OR = 0.51; 95% CI = 0.27–0.94) and a longer time to AIDS progression/death (stratified HR = 0.53; 95% CI = 0.30–0.92). The early ART had shorter time to achieving a CD4 count above 50 cells/mL (p<0.001) and no increase in adverse events. Conclusions Early ART resulted in less AIDS progression/death with no increase in adverse events or loss of virologic response compared to deferred ART. These results support the early initiation of ART in patients presenting with acute AIDS-related OIs, absent major contraindications. Trial Registration ClinicalTrials.gov NCT00055120
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            Prognosis of HIV-1-infected patients starting highly active antiretroviral therapy: a collaborative analysis of prospective studies

            Matthias Egger, Margaret May, Geneviève Chêne … (2002)
            Insufficient data are available from single cohort studies to allow estimation of the prognosis of HIV-1 infected, treatment-naive patients who start highly active antiretroviral therapy (HAART). The ART Cohort Collaboration, which includes 13 cohort studies from Europe and North America, was established to fill this knowledge gap.
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              The creation of a large UK-based multicentre cohort of HIV-infected individuals: The UK Collaborative HIV Cohort (UK CHIC) Study.

              (2004)
              This paper describes the development of the UK Collaborative HIV Cohort (CHIC) Study. The aim of the study is to collate routinely collected data on HIV-infected individuals attending one of seven clinical centres in the UK since 1 January 1996, with the objectives of describing changes over time in the frequency of AIDS-defining illnesses, describing the uptake of and response to highly active antiretroviral therapy (HAART), and identifying factors associated with virological and immunological responses to HAART. By December 2002, demographic, clinical and laboratory data had been collected on HIV-positive patients seen at six of the seven HIV centres. Missing and inconsistent data had been investigated and the datasets audited. Records identified as relating to the same patient had been merged, and cross-checks made with UK death registers to improve the accuracy of death reporting. The cohort currently contains information on 13,833 individuals. Eighty-two per cent of the cohort are male, and the median age was 34 years at first follow-up. The main risk factors for HIV infection have been determined as sex between men (63%) and sex between men and women (24%). Twenty-five per cent of the cohort are known to have developed AIDS, and 8% have died. The UK CHIC Study provides important information on the status of individuals infected with HIV in the UK, and provides a means to study the response to HAART and to monitor changes in the clinical event and death rates that have occurred since the introduction of HAART in the UK.
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                Author and article information

                Journal
                Title: HIV Medicine
                Abbreviated Title: HIV Med
                Publisher: Wiley
                ISSN: 14642662
                Publication date Created: April 2015
                Publication date (Print): April 2015
                Publication date (Electronic): December 18 2014
                Volume: 16
                Issue: 4
                Pages: 219-229
                Affiliations
                [1 ]UCL Research Department of Infection and Population Health; University College London; London UK
                [2 ]Decision Sciences in Infectious Disease: Prevention, Control, and Care; IAME; UMR 1137; Paris Diderot University; Sorbonne Paris Cité; Paris France
                [3 ]Department of Infectious Diseases; Lille School of Medicine; Tourcoing Hospital; Tourcoing France
                [4 ]Department of Infectious Diseases; Bichat-Claude Bernard Hospital; Paris France
                [5 ]The Mortimer Market Centre; Central and North West London NHS Foundation Trust; London UK
                Article
                DOI: 10.1111/hiv.12201
                PubMed ID: 25522796
                SO-VID: c264ad09-9da8-4669-bddb-c1dfe0c2ea61
                Copyright © © 2014
                License:

                http://doi.wiley.com/10.1002/tdm_license_1.1

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