Journal
JAIDS-JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES
Volume 47, Issue 1, Pages 27-35Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/QAI.0b013e31815acacc
Keywords
anemia; highly active antiretroviral therapy; peripheral neuropathy; renal insufficiency
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Funding
- PHS HHS [200-2001-00133] Funding Source: Medline
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Background: US guidelines recommend deferring initiation of highly active antiretroviral therapy (HAART) for most patients with CD4 counts >350 cells/mm(3) in part because of concerns about antiretroviral toxicity. Methods: Incidence rates of peripheral neuropathy, anemia, and renal insufficiency in a cohort of 2165 patients followed more than 3 years (mean) were analyzed in multivariate Cox proportional hazards models by CD4 cell counts at initiation of HAART. A nested cohort of 895 patients restricted to study participants who did or did not start HAART within a CD4 cell count stratum were also compared. Results: Incidence and risks of all 3 comorbidities decreased with initiation of HAART at CD4 counts >200 cells/mm(3) versus <200 cells/mm(3). Incidence and risks of renal insufficiency were similar with HAART initiation at CD4 counts >= 350 cells/mm(3) versus 200 to 349 cells/mm(3), but risk of peripheral neuropathy and anemia were further decreased in persons starting HAART at a CD4 count >= 350 cells/mm(3). The incidence of these conditions was highest during the first 6 months of treatment at any CD4 cell count and declined up to 19-fold with further therapy. Discussion: Initiating HAART at CD4 cell counts >= 200 cells/mm(3) reduced the incidence and risk of the 3, comorbid conditions and for anemia and peripheral neuropathy as well by starting at CD4 counts >= 350 cells/mm(3). The incidence of each condition decreased rapidly and remained low with increasing time on HAART.
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