Journal Article

Virological Control during the First 6–18 Months after Initiating Highly Active Antiretroviral Therapy as a Predictor for Outcome in HIV-Infected Patients: A Danish, Population-Based, 6-Year Follow-Up Study

Nicolai Lohse, Gitte Kronborg, Jan Gerstoft, Carsten Schade Larsen, Gitte Pedersen, Court Pedersen, Henrik Toft Sorensen and Niels Obel

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 42, issue 1, pages 136-144
Published in print January 2006 | ISSN: 1058-4838
Published online January 2006 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/498515
Virological Control during the First 6–18 Months after Initiating Highly Active Antiretroviral Therapy as a Predictor for Outcome in HIV-Infected Patients: A Danish, Population-Based, 6-Year Follow-Up Study

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Background. Our objective was to examine whether virological control during the first 6–18 months after HAART initiation is a predictor for viral suppression, CD4+ cell count increase, and mortality in human immunodeficiency virus (HIV)—infected patients 18–90 months after initiation of highly active antiretroviral therapy (HAART).

Methods. We conducted a population-based observational cohort study in Denmark. Patients were divided into 3 groups, according to the proportion of time each patient had a detectable HIV RNA load (i.e., ⩾ 400 copies/mL) during the 6–18 months after HAART initiation: 0% of the time interval (group 1), 1%–99% of the time interval (group 2), and 100% of the time interval (group 3). The proportion of patients with undetectable HIV RNA, CD4+ cell count changes, and mortality were examined by logistic, linear, and Cox regression analyses, respectively. We constructed cumulative mortality curves.

Results. We observed 2046 patients, for a total of 8898 person-years of follow-up that started at 18 months after HAART initiation. Mean CD4+ cell count increase rates during 72 months of follow-up were as follows: group 1, 3.3 × 106 cells/L per month (95% confidence interval [CI], 2.9–3.7 × 106 cells/L); group 2, 2.9 × 106 (95% CI, 2.5–3.3 × 106 cells/L); and group 3, 2.6 × 106 (95% CI, 2.0–3.3 × 106 cells/L). Survival at 72 months were as follows: group 1, 92.7% (95% CI, 90.5%–94.4%); group 2, 85.6% (95% CI, 82.1%–88.5%); and group 3, 76.1% (95% CI, 70.6%–80.7%). At 72 months, 96% of group 1, 83% of group 2, and 57% of group 3 had an HIV RNA load of <400 copies/mL (P <.01). Treatment interruption before baseline was a predictor of mortality in group 2 (adjusted rate ratio, 2.94; 95% CI, 1.75–4.92]).

Conclusions. Viral suppression during the first 6–18 months after HAART initiation predicts viral suppression, CD4+ cell count progression, and survival at 72 months.

Journal Article.  4376 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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