Prognosis of HIV-1-infected patients up to 5 years after initiation of HAART: collaborative analysis of prospective studies.
OBJECTIVE
To estimate the prognosis over 5 years of HIV-1-infected, treatment-naive patients starting HAART, taking into account the immunological and virological response to therapy.


METHODS
A collaborative analysis of data from 12 cohorts in Europe and North America on 20,379 adults who started HAART between 1995 and 2003.


METHODS
Parametric survival models were used to predict the cumulative incidence at 5 years of a new AIDS-defining event or death, and death alone, first from the start of HAART and second from 6 months after the start of HAART. Data were analysed by intention-to-continue-treatment, ignoring treatment changes and interruptions.


RESULTS
During 61 798 person-years of follow-up, 1005 patients died and an additional 1303 developed AIDS. A total of 10 046 (49%) patients started HAART either with a CD4 cell count of less than 200 cells/microl or with a diagnosis of AIDS. The 5-year risk of AIDS or death (death alone) from the start of HAART ranged from 5.6 to 77% (1.8-65%), depending on age, CD4 cell count, HIV-1-RNA level, clinical stage, and history of injection drug use. From 6 months the corresponding figures were 4.1-99% for AIDS or death and 1.3-96% for death alone.


CONCLUSIONS
On the basis of data collected routinely in HIV care, prognostic models with high discriminatory power over 5 years were developed for patients starting HAART in industrialized countries. A risk calculator that produces estimates for progression rates at years 1 to 5 after starting HAART is available from www.art-cohort-collaboration.org.
May
Margaret
M
Department of Social Medicine, University of Bristol, Canynge Hall, Whiteladies Road, Bristol, UK. m.t.may@bristol.ac.uk
Sterne
Jonathan A C
JA
Sabin
Caroline
C
Costagliola
Dominique
D
Justice
Amy C
AC
Thiébaut
Rodolphe
R
Gill
John
J
Phillips
Andrew
A
Reiss
Peter
P
Hogg
Robert
R
Ledergerber
Bruno
B
D'Arminio Monforte
Antonella
A
Schmeisser
Norbert
N
Staszewski
Shlomo
S
Egger
Matthias
M
D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy / Q000401:mortality; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D018791:CD4 Lymphocyte Count; D002170:Canada / Q000453:epidemiology; D005060:Europe / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000401:mortality; D015497:HIV-1; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012367:RNA, Viral / Q000032:analysis; D012307:Risk Factors; D017678:Sex Distribution; D014481:United States / Q000453:epidemiology; D019562:Viral Load
D012367:RNA, Viral