This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (306)  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Topic Collections  • HIV/AIDS  • Pathology & Laboratory Medicine  • Prognosis/ Outcomes  • Infectious Diseases  • Alert me on articles by topic  Social Bookmarking   What's this?

Robert S. Hogg, PhD; Benita Yip, BSc(Pharm); Keith J. Chan, MSc; Evan Wood, BSc; Kevin J. P. Craib, MMath; Michael V. O'Shaughnessy, OBC,PhD; Julio S. G. Montaner, MD,FRCPC,FCCP

JAMA. 2001;286:2568-2577.

Context  Current recommendations for initiation of antiretroviral therapy in patients infected with human immunodeficiency virus type 1 (HIV) are based on CD4 T-lymphocyte cell counts and plasma HIV RNA levels. The relative prognostic value of each marker following initiation of therapy has not been fully characterized.

Objective  To describe rates of disease progression to death and AIDS or death among patients starting triple-drug antiretroviral therapy, stratified by baseline CD4 cell count and HIV RNA levels.

Design, Setting, and Participants  Population-based analysis of 1219 antiretroviral therapy–naive HIV-positive men and women aged 18 years or older in British Columbia who initiated triple-drug therapy between August 1, 1996, and September 30, 1999.

Main Outcome Measure  Cumulative mortality rates from the initiation of triple-drug antiretroviral therapy to September 30, 2000, determined using various CD4 cell and plasma HIV RNA thresholds.

Results  As of September 30, 2000, 82 patients had died of AIDS-related causes, for a crude AIDS-related mortality rate of 6.7%. The product limit estimate (SE) of the cumulative mortality rate at 12 months was 2.9% (0.5%). In univariate analyses, a prior diagnosis of acquired immunodeficiency syndrome (AIDS), CD4 cell count, use of protease inhibitors, and HIV RNA level were associated with mortality. There was no difference in mortality by age or sex. Only CD4 cell count remained statistically significant in the multivariate analysis. After controlling for AIDS, protease inhibitor use, and plasma HIV RNA level at baseline, patients with CD4 cell counts of less than 50/µL were 6.67 (95% confidence interval [CI], 3.61-12.34) times and those with counts of 50/µL to 199/µL were 3.41 (95% CI, 1.93-6.03) times more likely to die than those with counts of at least 200/µL.

Conclusion  Our data demonstrate uniformly low rates of disease progression to death and AIDS or death among patients starting antiretroviral therapy with CD4 cell counts of at least 200/µL. In our study, disease progression to death and AIDS or death was clustered among patients starting therapy with CD4 cell counts less than 200/µL.

Author Affiliations: BC Centre for Excellence in HIV/AIDS (Drs Hogg, O'Shaughnessy, and Montaner, Ms Yip, and Messrs Chan, Wood, and Craib); Departments of Pathology and Laboratory Medicine (Dr O'Shaughnessy), Medicine (Dr Montaner), and Health Care and Epidemiology (Dr Hogg), Faculty of Medicine, University of British Columbia, Vancouver, British Columbia. Mr Wood is a doctoral candidate in the Department of Health Care and Epidemiology.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Evaluation of HIV/AIDS clinical care quality: the case of a referral hospital in North West Ethiopia
Alemayehu et al.
Int J Qual Health Care 2009;21:356-362.
ABSTRACT | FULL TEXT  

Five-Year Outcomes of the China National Free Antiretroviral Treatment Program
Zhang et al.
ANN INTERN MED 2009;151:241-251.
ABSTRACT | FULL TEXT  

Correlates of HIV-1 viral suppression in a cohort of HIV-positive drug users receiving antiretroviral therapy in Hanoi, Vietnam
Jordan et al.
Int J STD AIDS 2009;20:418-422.
ABSTRACT | FULL TEXT  

Effect of Early versus Deferred Antiretroviral Therapy for HIV on Survival
Kitahata et al.
NEJM 2009;360:1815-1826.
ABSTRACT | FULL TEXT  

Impact of HAART Therapy on Co-Infection of Tuberculosis and HIV Cases for 9 Years in Taiwan
Tseng et al.
Am J Trop Med Hyg 2009;80:675-677.
ABSTRACT | FULL TEXT  

Epidemiological Characterization of Individuals With Newly Reported HIV Infection: South Carolina, 2004-2005
Ogbuanu et al.
AJPH 2009;99:S111-S117.
ABSTRACT | FULL TEXT  

Safety and Efficacy of Enfuvirtide in Combination with Darunavir-Ritonavir and an Optimized Background Regimen in Treatment-Experienced Human Immunodeficiency Virus-Infected Patients: the Below the Level of Quantification Study
DeJesus et al.
Antimicrob. Agents Chemother. 2008;52:4315-4319.
ABSTRACT | FULL TEXT  

Nonadherence Increases the Risk of Hospitalization Among HIV-Infected Antiretroviral Naive Patients Started on HAART
Fielden et al.
J Int Assoc Physicians AIDS Care (Chic Ill) 2008;7:238-244.
ABSTRACT  

Highly Active Antiretroviral Therapy and Survival in HIV-Infected Injection Drug Users
Wood et al.
JAMA 2008;300:550-554.
ABSTRACT | FULL TEXT  

The Economic Impact of AIDS Treatment: Labor Supply in Western Kenya
Thirumurthy et al.
J. Human Resources 2008;43:511-552.
ABSTRACT  

Gastrointestinal complications of HIV infection: changing priorities in the HAART era
Wilcox and Saag
Gut 2008;57:861-870.
ABSTRACT | FULL TEXT  

Immunological Responses and Long-Term Treatment Interruption after Human Immunodeficiency Virus Type 1 (HIV-1) Lipopeptide Immunization of HIV-1-Infected Patients: the LIPTHERA Study
Pialoux et al.
CVI 2008;15:562-568.
ABSTRACT | FULL TEXT  

Influence of Alternative Thresholds for Initiating HIV Treatment on Quality-Adjusted Life Expectancy: A Decision Model
Braithwaite et al.
ANN INTERN MED 2008;148:178-185.
ABSTRACT | FULL TEXT  

The Optimal Time to Initiate HIV Therapy Under Ordered Health States
Shechter et al.
Operations Research 2008;56:20-33.
ABSTRACT  

Determining Human Immunodeficiency Virus Coreceptor Use in a Clinical Setting: Degree of Correlation between Two Phenotypic Assays and a Bioinformatic Model
Skrabal et al.
J. Clin. Microbiol. 2007;45:279-284.
ABSTRACT | FULL TEXT  

Antiretroviral treatment of HIV infected adults.
Deeks
BMJ 2006;332:1489-1489.
FULL TEXT  

Barriers to Antiretroviral Medication Adherence in Young HIV-Infected Children
Roberts
Youth Society 2005;37:230-245.
ABSTRACT  

Clinical practice. Management of newly diagnosed HIV infection.
Hammer
NEJM 2005;353:1702-1710.
FULL TEXT  

Effectiveness of Highly Active Antiretroviral Therapy among Injection Drug Users with Late-Stage Human Immunodeficiency Virus Infection
Vlahov et al.
Am J Epidemiol 2005;161:999-1012.
ABSTRACT | FULL TEXT  

Cost-Effectiveness of Screening for HIV in the Era of Highly Active Antiretroviral Therapy
Sanders et al.
NEJM 2005;352:570-585.
ABSTRACT | FULL TEXT  

Antiretroviral Therapy in Advanced HIV-1 Infection
Post and Easterbrook
J Int Assoc Physicians AIDS Care (Chic Ill) 2005;4:8-15.
ABSTRACT  

Memory Responses in Human Immunodeficiency Virus Type 1-Infected Individuals with Long-Term Viral Load Suppression Are Independent of CD4 Cell Nadir
Kolber et al.
CVI 2005;12:76-80.
ABSTRACT | FULL TEXT  

Gender differences in progression to AIDS and death from HIV seroconversion in a cohort of injecting dug users from 1986 to 2001
de la Hera et al.
J. Epidemiol. Community Health 2004;58:944-950.
ABSTRACT | FULL TEXT  

Low CD4+ T-Lymphocyte Values in Human Immunodeficiency Virus-Negative Adults in Botswana
Bussmann et al.
CVI 2004;11:930-935.
ABSTRACT | FULL TEXT  

Central Memory CD4+ T Cell Responses in Chronic HIV Infection Are Not Restored by Antiretroviral Therapy
Elrefaei et al.
J. Immunol. 2004;173:2184-2189.
ABSTRACT | FULL TEXT  

De novo T-cell generation in patients at different ages and stages of HIV-1 disease
Nobile et al.
Blood 2004;104:470-477.
ABSTRACT | FULL TEXT  

Starting highly active antiretroviral therapy: why, when and response to HAART
Mocroft and Lundgren
J Antimicrob Chemother 2004;54:10-13.
ABSTRACT | FULL TEXT  

The Prognostic Importance of Changes in CD4+ Cell Count and HIV-1 RNA Level in Women after Initiating Highly Active Antiretroviral Therapy
Anastos et al.
ANN INTERN MED 2004;140:256-264.
ABSTRACT | FULL TEXT  

Starting Highly Active Antiretroviral Therapy for HIV Infection: Is It WIHS To Wait?
Schooley
ANN INTERN MED 2004;140:305-306.
FULL TEXT  

Effect of Medication Adherence on Survival of HIV-Infected Adults Who Start Highly Active Antiretroviral Therapy When the CD4+ Cell Count Is 0.200 to 0.350 x 109 cells/L
Wood et al.
ANN INTERN MED 2003;139:810-816.
ABSTRACT | FULL TEXT  

Individuals taking combination therapies for HIV or AIDS faced barriers to remaining in, or returning to work
Goldstone
Evid. Based Nurs. 2003;6:124-124.
FULL TEXT  

Effect of Highly Active Antiretroviral Therapy on Time to Acquired Immunodeficiency Syndrome or Death using Marginal Structural Models
Cole et al.
Am J Epidemiol 2003;158:687-694.
ABSTRACT | FULL TEXT  

Adherence and plasma HIV RNA responses to highly active antiretroviral therapy among HIV-1 infected injection drug users
Wood et al.
CMAJ 2003;169:656-661.
ABSTRACT | FULL TEXT  

Antigen-Presenting Cell Modulation Induces a Memory Response to p24 in Peripheral Blood Leukocytes from Human Immunodeficiency Virus-Infected Individuals
Kolber and Saenz
CVI 2003;10:757-763.
ABSTRACT | FULL TEXT  

Human Immunodeficiency Virus Infection: A Focus on Women
Pakyz et al.
Journal of Pharmacy Practice 2003;16:170-181.
ABSTRACT  

Multiple Viral Genetic Analyses Detect Low-Level Human Immunodeficiency Virus Type 1 Replication during Effective Highly Active Antiretroviral Therapy
Frenkel et al.
J. Virol. 2003;77:5721-5730.
ABSTRACT | FULL TEXT  

When to Initiate Highly Active Antiretroviral Therapy: A Cohort Approach
Ahdieh-Grant et al.
Am J Epidemiol 2003;157:738-746.
ABSTRACT | FULL TEXT  

Survival Benefit of Initiating Antiretroviral Therapy in HIV-Infected Persons in Different CD4+ Cell Strata
Palella et al.
ANN INTERN MED 2003;138:620-626.
ABSTRACT | FULL TEXT  

When To Start Therapy for HIV Infection: A Swinging Pendulum in Search of Data
Lane and Neaton
ANN INTERN MED 2003;138:680-681.
FULL TEXT  

Update in Infectious Diseases
Lorber
ANN INTERN MED 2002;137:974-980.
FULL TEXT  

Risk of Progression to AIDS and Death in Women Infected With HIV-1 Initiating Highly Active Antiretroviral Treatment at Different Stages of Disease
Anastos et al.
Arch Intern Med 2002;162:1973-1980.
ABSTRACT | FULL TEXT  

Guidelines for Using Antiretroviral Agents among HIV-Infected Adults and Adolescents: The Panel on Clinical Practices for Treatment of HIV
Dybul et al.
ANN INTERN MED 2002;137:381-433.
ABSTRACT | FULL TEXT  

Chronic HIV Infection: Can Anyone Afford a Drug Holiday?
Kane
ANN INTERN MED 2002;137:301-304.
FULL TEXT  

Antiretroviral Treatment for Adult HIV Infection in 2002: Updated Recommendations of the International AIDS Society-USA Panel
Yeni et al.
JAMA 2002;288:222-235.
ABSTRACT | FULL TEXT  

Full Adherence to HAART: Is It Really Necessary?
Cainelli et al.
Arch Intern Med 2002;162:944-945.
FULL TEXT  

When to Start HIV Treatment: A Work in Progress
JWatch Gastroenterology 2002;2002:12-12.
FULL TEXT  

When to Start Antiretroviral Therapy -- Additional Insights
JWatch Infect. Diseases 2001;2001:1-1.
FULL TEXT  

When to Start HIV Treatment: A Work in Progress
JWatch General 2001;2001:1-1.
FULL TEXT  

Initiating Antiretroviral Therapy During HIV Infection: Confusion and Clarity
Pomerantz
JAMA 2001;286:2597-2599.
FULL TEXT