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Title

Inferior clinical outcome of the CD4+ cell count-guided antiretroviral treatment interruption strategy in the SMART study: role of CD4+ Cell counts and HIV RNA levels during follow-up

Authors
Lundgren, J. D.
Babiker, A.
El-Sadr, W.
Grund, B.
Neaton, J. D.
Neuhaus, J.
Phillips, A. N.
Published in The Journal of Infectious Diseases. 2008, vol. 197, no. 8, p. 1145-1155
Abstract BACKGROUND AND METHODS: The SMART study compared 2 strategies for using antiretroviral therapy-drug conservation (DC) and viral suppression (VS)-in 5,472 human immunodeficiency virus (HIV)-infected patients with CD4+ cell counts >350 cells/microL. Rates and predictors of opportunistic disease or death (OD/death) and the relative risk (RR) in DC versus VS groups according to the latest CD4+ cell count and HIV RNA level are reported. RESULTS: During a mean of 16 months of follow-up, DC patients spent more time with a latest CD4+ cell count <350 cells/microL (for DC vs. VS, 31% vs. 8%) and with a latest HIV RNA level >400 copies/mL (71% vs. 28%) and had a higher rate of OD/death (3.4 vs. 1.3/100 person-years) than VS patients. For periods of follow- up with a CD4+ cell count <350 cells/microL, rates of OD/death were increased but similar in the 2 groups (5.7 vs. 4.6/100 person-years), whereas the rates were higher in DC versus VS patients (2.3 vs. 1.0/100 person-years; RR, 2.3 [95% confidence interval, 1.5-3.4]) for periods with the latest CD4+ cell count ≥ 350 cells/microL-an increase explained by the higher HIV RNA levels in the DC group. CONCLUSIONS: The higher risk of OD/death in DC patients was associated with (1) spending more follow-up time with relative immunodeficiency and (2) living longer with uncontrolled HIV replication even at higher CD4+ cell counts. Ongoing HIV replication at a given CD4+ cell count places patients at an excess risk of OD/death.
Keywords AIDS-Related Opportunistic Infections/epidemiology/mortalityAnti-HIV Agents/*administration & dosage*CD4 Lymphocyte CountDrug Administration ScheduleHIV/*genetics/*immunologyHIV Infections/*drug therapy/immunology/mortality/virologyHumansProportional Hazards ModelsRNA, Viral/*bloodTreatment Outcome
Identifiers
PMID: 18476293
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Other version: http://jid.oxfordjournals.org/content/197/8/1145.full.pdf
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LUNDGREN, J. D. et al. Inferior clinical outcome of the CD4+ cell count-guided antiretroviral treatment interruption strategy in the SMART study: role of CD4+ Cell counts and HIV RNA levels during follow-up. In: The Journal of Infectious Diseases, 2008, vol. 197, n° 8, p. 1145-1155. https://archive-ouverte.unige.ch/unige:19145

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Deposited on : 2012-03-27

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