Limiting Cumulative HIV Viremia Copy-Years by Early Treatment Reduces Risk of AIDS and Death
Olson, Ashley D. (Medical Research Council Clinical Trials Unit, University College London, London, United Kingdom)
Walker, A. Sarah (Medical Research Council Clinical Trials Unit, University College London, London, United Kingdom)
Suthar, Amitabh B. (South African Centre for Epidemiological Modelling and Analysis, University of Stellenbosch, South Africa)
Sabin, Caroline A. (Department of Infection and Population Health, University College London (UCL), London, United Kingdom)
Bucher, Heiner (University Hospital Basel (Basilea, Suïssa))
Jarrín, Inmaculada (Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública)
Moreno, Santiago (Instituto Ramón y Cajal de Investigación Sanitaria (Madrid))
Pérez-Hoyos, Santiago (Hospital Universitari Vall d'Hebron)
Porter, Kholoud (Medical Research Council Clinical Trials Unit, University College London, London, United Kingdom)
Ford, Deborah (Medical Research Council Clinical Trials Unit, University College London, London, United Kingdom)
Universitat Autònoma de Barcelona

Date:	2016
Abstract:	Supplemental Digital Content is Available in the Text. Viremia copy-years (VCY), a time-updated measure of cumulative HIV exposure, predicts AIDS/death; although its utility in deciding when to start combination antiretroviral therapy (cART) remains unclear. We aimed to assess the impact of initiating versus deferring cART on risk of AIDS/death by levels of VCY both independent of and within CD4 cell count strata ≥500 cells per cubic millimeter. Using Concerted Action on Seroconversion to AIDS and Death in Europe (CASCADE) data, we created a series of nested "trials" corresponding to consecutive months for individuals ≥16 years at seroconversion after 1995 who were cART-naive and AIDS-free. Pooling across all trials, time to AIDS/death by CD4, and VCY strata was compared in those initiating vs. deferring cART using Cox models adjusted for: country, sex, risk group, seroconversion year, age, time since last HIV-RNA, and current CD4, VCY, HIV-RNA, and mean number of previous CD4/HIV-RNA measurements/year. Of 9353 individuals, 5312 (57%) initiated cART and 486 (5%) acquired AIDS/died. Pooling CD4 strata, risk of AIDS/death associated with initiating vs. deferring cART reduced as VCY increased. In patients with high CD4 cell counts, ≥500 cells per cubic millimeter, there was a trend for a greater reduction for those initiating vs. deferring with increasing VCY (P = 0. 09), with the largest benefit in the VCY ≥100,000 copy-years/mL group [hazard ratio (95% CI) = 0. 41 (0. 19 to 0. 87)]. For individuals with CD4 ≥500 cells per cubic millimeter, limiting the cumulative HIV burden to <100,000 copy-years/mL through cART may reduce the risk of AIDS/death.
Note:	Altres ajuts: The research leading to these results has received funding from the European Union Seventh Framework Programme (FP7/2007-2013) under EuroCoord grant agreement n° 260694 and Medical Research Council UK.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Viremia copy-years ; Seroconverters ; When to start ; CART initiation ; CD4 cell count ; HIV-RNA
Published in:	Journal of acquired immune deficiency syndromes (1999), Vol. 73 (august 2016) , p. 100-108, ISSN 1944-7884

DOI: 10.1097/QAI.0000000000001029
PMID: 27116045

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