Effect of Immediate Initiation of Antiretroviral Treatment in HIV-Positive Individuals Aged 50 Years or Older.
Lodi, Sara PhD 1; Costagliola, Dominique PhD 2; Sabin, Caroline PhD 3; del Amo, Julia PhD 4,5; Logan, Roger PhD 1; Abgrall, Sophie MD 2,6; Reiss, Peter MD 7,8,9; van Sighem, Ard PhD 7; Jose, Sophie MSc 3; Blanco, Jose-Ramon MD, PhD 10; Hernando, Victoria PhD 4,5; Bucher, Heiner C. MD, MPH 11; Kovari, Helen MD 12; Segura, Ferran MD 13; Ambrosioni, Juan MD, PhD 14; Gogos, Charalambos A. MD, PhD 15; Pantazis, Nikos PhD 16; Dabis, Francois MD, PhD 17,18; Vandenhende, Marie-Anne MD, PhD 17,18,19; Meyer, Laurence PhD 20,21,22; Seng, Remonie MD, MPH 21,22; Gill, M. John MB 23,24; Krentz, Hartmut PhD 23,24; Phillips, Andrew N. PhD 4; Porter, Kholoud PhD 4; Grinsztejn, Beatriz MD 25; Pacheco, Antonio G. MD, PhD 26; Muga, Roberto MD 27; Tate, Janet ScD 28; Justice, Amy MD, PhD 28,29; Hernan, Miguel A. MD, PhD 1,30,31
[Article]
JAIDS Journal of Acquired Immune Deficiency Syndromes.
76(3):311-318, November 1, 2017.
(Format: HTML, PDF)
Background: Clinical guidelines recommend immediate initiation of combined antiretroviral therapy for all HIV-positive individuals. However, those guidelines are based on trials of relatively young participants.
Methods: We included HIV-positive antiretroviral therapy-naive, AIDS-free individuals aged 50-70 years after 2004 in the HIV-CAUSAL Collaboration. We used the parametric g-formula to estimate the 5-year risk of all-cause and non-AIDS mortality under (1) immediate initiation at baseline and initiation at CD4 count, (2) <500 cells/mm3, and (3) <350 cells/mm3. Results were presented separately for the general HIV population and for a US Veterans cohort with high mortality.
Results: The study included 9596 individuals (28% US Veterans) with median (interquantile range) age of 55 (52-60) years and CD4 count of 336 (182-513) at baseline. The 5-year risk of all-cause mortality was 0.40% (95% confidence interval (CI): 0.10 to 0.71) lower for the general HIV population and 1.61% (95% CI: 0.79 to 2.67) lower for US Veterans when comparing immediate initiation vs initiation at CD4 <350 cells/mm3. The 5-year risk of non-AIDS mortality was 0.17% (95% CI: -0.07 to 0.43) lower for the general HIV population and 1% (95% CI: 0.31 to 2.00) lower for US Veterans when comparing immediate initiation vs initiation at CD4 <350 cells/mm3.
Conclusions: Immediate initiation seems to reduce all-cause and non-AIDS mortality in patients aged 50-70 years.
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