title: Risk of progression to AIDS and death in women infected with HIV-1 initiating highly active antiretroviral treatment at different stages of disease.
abstract: BACKGROUND
  The optimal virologic and immunologic stage at which to initiate antiretroviral therapy in individuals infected with human immunodeficiency virus type 1 (HIV-1) is undefined.
  
  
  METHODS
  Among 1054 HIV-1-infected women in a prospective cohort study, we determined the time from initiation of highly active antiretroviral treatment (HAART) to acquired immunodeficiency syndrome (AIDS) and death.
  
  
  RESULTS
  Median follow-up was 3.4 years. Of 553 women without AIDS at HAART initiation, 62 (11%) developed AIDS. Compared with women with CD4(+) cell counts greater than 350/microL at HAART initiation, women with cell counts of 200 to 350/microL and less than 200/microL had relative hazards (RHs) for progression to AIDS of 0.93 (95% confidence interval [CI], 0.46-1.86) and 2.48 (95% CI, 1.39-4.42), respectively. Compared with those with HIV-1 RNA values less than 5000 copies/mL, women with 5000 to 50,000 copies/mL and greater than 50,000 copies/mL had RHs of 1.39 (95% CI, 0.74-2.64) and 2.09 (95% CI, 1.09-3.99), respectively. Among women with AIDS at HAART initiation (n = 501), RHs of death were 1.97 (95% CI, 0.84-4.66) and 3.35 (95% CI, 1.59-7.08) with CD4(+) cell counts of 200 to 350/microL and less than 200/microL, respectively, relative to those with greater than 350/microL, and 1.90 (95% CI, 0.84-4.30) and 3.70 (95% CI, 1.81-7.54) for those with HIV-1 RNA values of 5000 to 50,000 and greater than 50,000 copies/mL, respectively, relative to those with less than 5000 copies/mL.
  
  
  CONCLUSIONS
  Progression to AIDS and death was predicted by pre-HAART values of less than 200/microL for CD4(+) cells and greater than 50,000 HIV-1 RNA copies/mL, indicating that deferral of HAART until the CD4(+) cell count is between 350 and 200/microL is a valid strategy in the clinical management of HIV-1 infection.
authors.affiliation: Department of Internal Medicine, Montefiore Medical Center and Lincoln Medical and Mental Health Center, Bronx, NY 10451, USA. kanasto@aol.com
authors.forename: Kathryn
authors.initials: K
authors.lastname: Anastos
authors.forename: Yolanda
authors.initials: Y
authors.lastname: Barrón
authors.forename: Paolo
authors.initials: P
authors.lastname: Miotti
authors.forename: Barbara
authors.initials: B
authors.lastname: Weiser
authors.forename: Mary
authors.initials: M
authors.lastname: Young
authors.forename: Nancy
authors.initials: N
authors.lastname: Hessol
authors.forename: Ruth M
authors.initials: RM
authors.lastname: Greenblatt
authors.forename: Mardge
authors.initials: M
authors.lastname: Cohen
authors.forename: Michael
authors.initials: M
authors.lastname: Augenbraun
authors.forename: Alexandra
authors.initials: A
authors.lastname: Levine
authors.forename: Alvaro
authors.initials: A
authors.lastname: Muñoz
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000401:mortality / Q000628:therapy* / Q000821:virology*; D000328:Adult; D000368:Aged; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006679:HIV Seropositivity / Q000401:mortality / Q000628:therapy / Q000821:virology; D015497:HIV-1; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D016387:Women's Health