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Effect of Immediate Initiation of Antiretroviral Treatment in HIV-Positive Individuals Aged 50 Years or Older.

Type of publication Peer-reviewed
Publikationsform Original article (peer-reviewed)
Author Lodi Sara, Costagliola Dominique, Sabin Caroline, Del Amo Julia, Logan Roger, Abgrall Sophie, Reiss Peter, van Sighem Ard, Jose Sophie, Blanco Jose-Ramon, Hernando Victoria, Bucher Heiner C, Kovari Helen, Segura Ferran, Ambrosioni Juan, Gogos Charalambos A, Pantazis Nikos, Dabis Francois, Vandenhende Marie-Anne, Meyer Laurence, Seng Rémonie, Gill M John, Krentz Hartmut, Phillips Andrew N, Porter Kholoud, Grinsztejn Beatriz, Pacheco Antonio G, Muga Roberto, Tate Janet, Justice Amy, Hernán Miguel A,
Project Swiss HIV Cohort Study (SHCS)
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Original article (peer-reviewed)

Journal Journal of acquired immune deficiency syndromes (1999)
Page(s) 311 - 318
Title of proceedings Journal of acquired immune deficiency syndromes (1999)
DOI 10.1097/qai.0000000000001498

Open Access

URL https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5704899/
Type of Open Access Repository (Green Open Access)

Abstract

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. 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/mm, and (3) <350 cells/mm. Results were presented separately for the general HIV population and for a US Veterans cohort with high mortality. 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/mm. 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/mm. Immediate initiation seems to reduce all-cause and non-AIDS mortality in patients aged 50-70 years.
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