Clinical Progression Rates by CD4 Cell Category Before and After Starting Antiretroviral Therapy
Author Information
Author(s): Guiguet Marguerite, Porter Kholoud, Phillips Andrew, Costagliola Dominique, Babiker Abdel
Primary Institution: INSERM U720, Paris, France
Hypothesis
What are the rates of AIDS defining events and death by CD4 and HIV RNA categories before and after starting combination antiretroviral therapy?
Conclusion
The risk of AIDS defining events is higher before starting antiretroviral therapy compared to after initiation for patients with CD4 counts above 200 cells/mm3.
Supporting Evidence
- Patients with CD4 counts below 500 cells/mm3 had nearly double the risk of AIDS defining events before starting treatment compared to after.
- After adjusting for HIV RNA, the risk of AIDS defining events became similar for both treatment groups except for those with CD4 counts below 200 cells/mm3.
- Event rates were significantly higher in ART-naive individuals with lower CD4 counts.
Takeaway
People with HIV have a higher risk of getting sick before they start treatment compared to after they start taking medicine, especially if their CD4 count is above 200.
Methodology
The study used a Poisson regression model to estimate event rates within CD4 cell strata, adjusting for various confounders.
Potential Biases
Unmeasured confounders may affect the comparison of event rates between treated and untreated individuals.
Limitations
The study included both naive and pre-treated individuals in the cART category, which may affect event rates, and some deaths had no recorded cause.
Participant Demographics
The study included 7317 ART-naive and 6376 cART patients, with a median baseline CD4 of 477 cells/mm3 for naive and 310 cells/mm3 for cART.
Statistical Information
P-Value
0.002
Confidence Interval
95% CI 4-140
Statistical Significance
p<0.05
Digital Object Identifier (DOI)
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