Prognosis of HIV Positive Patients Up To 5 Years after Initiation of HAART
For
several years, the Antiretroviral Therapy Cohort Collaboration has been following
the progression of HIV positive patients starting HAART.
As
reported in the May 31, 2007 issue of AIDS, the researchers estimated the
prognosis over 5 years of treatment-naive patients initiating antiretroviral therapy,
taking into account immunological and virological response
to treatment.
The
collaborative analysis included data from 12 cohorts in Europe and North America, representing 20,379 adults who started HAART
between 1995 and 2003.
Parametric
survival models were used to predict the cumulative incidence at 5 years of new
AIDS-defining events or deaths, and deaths alone, both from the start of HAART
and from 6 months after the start of HAART. Data were analyzed by intention-to-continue-treatment,
ignoring treatment changes and interruptions.
Results
1005 patients died during 61,798
person-years of follow-up.
An additional 1303 developed AIDS.
A total of 10,046 patients (49%)
started HAART either with a CD4 cell count of less than
200 cells/mm3 or with a pre-existing AIDS diagnosis.
The 5-year risk of AIDS or death
from the start of HAART ranged from 5.6% to 77%, depending on age, CD4 cell count,
HIV RNA level, clinical stage, and history of injection drug use.
For death alone, the range was
1.8% to 65%.
From 6 months after the start
of HAART, the corresponding range for AIDS or death was 4.1% to 99%.
The corresponding range for death
alone was 1.3% to 96%.
Conclusion
In
conclusion, the authors wrote, “On the basis of data collected routinely in HIV
care, prognostic models with high discriminatory power over 5 years were developed
for patients starting HAART in industrialized countries.”
Based
on this data, the researchers produced a risk calculator that provides estimates
for progression rates 1-5 after starting HAART, allowing users to plug in patient-specific
variables such as age and CD4 count. The calculator is available at www.art-cohort-collaboration.org.
06/01/07
Reference Antiretroviral Therapy Cohort Collaboration. Prognosis of HIV-1-infected patients
up to 5 years after initiation of HAART: collaborative analysis of prospective
studies. AIDS 21(9): 1185-1197. May 31, 2007.
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