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Abstract
BASELINE CD4 CELL COUNT, ADHERENCE, AND SURVIVAL IMPLICATIONS OF THE TIMING OF ANTIRETROVIRAL THERAPY IN HIV-INFECTED ADULTS
E. Wood, R.S. Hogg, B. Yip, P.R. Harrigan, M.V. O’Shaughnessy, J.S. Montaner
British Columbia Centre for Excellence in HIV/AIDS, University of British Colubia, Vancouver, Canada
Background: There has been conflicting evidence regarding the safety of delaying HAART when CD4 cell count declines below 350 cells/ÁL. However, all earlier studies have been limited in that they have not considered patient non-adherence. We sought to evaluate the impact of baseline CD4 cell count and adherence on survival rates among unselected patients initiating HAART.
Methods: Population-based analysis of the time to death among antiretroviral na´ve patients who initiated HAART between August 1, 1996 and July 31, 2000, and were followed until March 31, 2002. Patients were stratified by baseline CD4 cell count and into adherent and non-adherent groups. Cox regression was used to calculate adjusted relative hazards.
Results: Overall, 1422 patients initiated HAART during the study period. In stratified Kaplan-Meier analyses, there was no survival benefit of initiating HAART > 200 cells/ÁL among adherent patients. In adjusted analysis, in comparison to adherent patients who initiated HAART > 350 cells/ÁL, non-adherent patients who initiated HAART when CD4 cell count was 200 – 349 cells/ÁL had statistically elevated mortality rates (Adjusted Relative Hazard [ARH]: 2.56 [95% CI: 1.36 – 4.84]; p = 0.004). However, in comparison to adherent patients who initiated HAART > 350 cells/ÁL, adherent patients who initiated HAART when CD4 cell count was 200 – 349 cells/ÁL had statistically similar mortality rates (ARH: 0.82 [95% CI: 0.45 – 1.49]; p = 0.521).
Conclusions: We found no survival benefit of initiating HAART prior to 200 cells/ÁL among unselected patients who were conservatively defined as adherent. Since mortality was only elevated among non-adherent patients, these data suggest that incomplete adherence is the strongest determinant of patient survival, instead of when antiretroviral therapy is initiated prior to prior to 200 cells/ÁL.
The 2nd IAS Conference on HIV Pathogenesis and Treatment
Abstract no.
564
Suggested Citation
" E. Wood, et al.
BASELINE CD4 CELL COUNT, ADHERENCE, AND SURVIVAL IMPLICATIONS OF THE TIMING OF ANTIRETROVIRAL THERAPY IN HIV-INFECTED ADULTS.
Poster:
The 2nd IAS Conference on HIV Pathogenesis and Treatment:
Abstract no.
564"
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