Limiting Cumulative HIV Viremia Copy-Years by Early Treatment Reduces Risk of AIDS and Death

作者：Olson Ashley D^*; Walker A Sarah; Suthar Amitabh B; Sabin Caroline; Bucher Heiner C; Jarrin Inma; Moreno Santiago; Perez Hoyos Santiago; Porter Kholoud; Ford Deborah

来源：JAIDS: Journal of Acquired Immune Deficiency Syndromes , 2016, 73(1): 100-108.

DOI：10.1097/QAI.0000000000001029

• viremia copy-years
• seroconverters
• when to start
• cART initiation
• CD4 cell count
• HIV-RNA

Background: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.Methods: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.Results: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)].Conclusions: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.

• 出版日期2016-9-1