期刊
AIDS
卷 24, 期 12, 页码 1867-1876出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/QAD.0b013e32833adbcf
关键词
antiretroviral therapy; HIV/AIDS; long-term CD4(+) T-cell count; loss to follow-up; observational data
资金
- NIAID [AI 38858, AI 68636, AI 069434, AI 069472, AI 062435, AI069474, AI27664, AI69432]
- Statistical and Data Management Center [AI 38855, AI 68634]
- National Institute of Health [NIAID R01 AI 51164, AI 024643, NIH- R01- GM48704]
- CTU [AI069472]
- CFAR [P30 AI060354 A0104]
- Boston Medical Center ACTG CRS
- GCRC [RR00096]
- University of Cincinnati, Judith Feinberg, MD [AI25879, AI69501]
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 (<= 200, 201-350, 351-500, and > 500 cells/mu l). Results: Median CD4 cell count increased from 270 cells/mu l pre-ART to an estimated 556 cells/mu l at 3 and 532 cells/mu l at 7 years after starting ART in analyses ignoring treatment discontinuations, and to 570 and 640 cells/mu l, respectively, had all patients continuedART. However, even hadARTbeen continued, an estimated 25, 9, 3, and2% of patients with pretreatment CD4 cell counts of 200 or less, 201 -350, 351 -500, and more than 500 cells/mu l would have had CD4 cell counts of 350 cells/mu l 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. (C) 2010 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins
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