Determinants of HIV Progression and Assessment of the Optimal Time to Initiate Highly Active Antiretroviral Therapy

• DOI: 10.1097/qai.0b013e31815ee282
• Publication Date: 2009-03-05T06:01:31Z
• Authors: Ángeles Jaén; Anna Esteve; Josep M Miró; Cristina Tural; Alexandra Montoliu; Elena Ferrer; Melcior Riera; Ferran Segura; Lluis Force; Omar Sued; Josep Vilaró; Isabel Garcia; Angels Masabeu; Jordi Altès; Bonaventura Clotet; Daniel Podzamczer; Javier Murillas; Gemma Navarro; Josep M Gatell; Jordi Casabona
• Keywords: Hepatitis C

Objective: We analyze the factors related to progression AIDS or death in HIV-infected patients from Proyecto para la Informatización del Seguimiento Clínico epidemiológico de los pacientes con Infección por VIH/SIDA (PISCIS) Cohort and we assess optimal time initiate highly active antiretroviral therapy (HAART) taking lead into account. Methods: selected naive who were AIDS-free initiated HAART after January 1998. Statistical analyses performed using Cox proportional hazards models. Lead was defined as it took deferred group with an early disease stage reach later stage. The analysis accounting for multiple imputation methods based on estimates pre-HAART period described elsewhere. Results: Multivariate 2035 (median follow-up = 34.3 months) showed significantly higher hazard ratios (HRs) a CD4 count <200 cells/μL (HR 3.79, 95% confidence interval [CI]: 2.18 6.57), HIV-1 RNA level >100,000 copies/mL 1.84, CI: 1.26 2.69), hepatitis C virus (HCV) coinfection 2.40, 1.65 3.49), whereas lower risk found those started between 2001 June 2004 0.55, 0.30 0.90). When unseen events included, of among treatment when reached 2.97, 1.91 4.63) 200 350 1.85, 1.03 3.33) compared counts >350 cells/μL, respectively. Conclusions: Advanced HIV disease, HCV coinfection, determinants death. Lead-time asymptomatic suggests that best start is before falls than cells/μL.