title: A decision tree to help determine the best timing and antiretroviral strategy in HIV-infected patients.
abstract: Optimal antiretroviral strategies for HIV-infected patients still need to be established. To this end a decision tree including different antiretroviral strategies that could be adopted for HIV-infected patients was built. A 10-year follow-up was simulated by using transitional probabilities estimated from a large cohort using a time-homogeneous Markov model. The desired outcome was for patients to maintain a CD4 cell count of >500 cells/mm3 without experiencing AIDS or death. For patients with a baseline HIV viral load ≥5 log10 copies/ml, boosted protease inhibitor-based immediate highly active antiretroviral therapy (HAART) allowed them to spend 12% more time with CD4 ≥500/mm3 than did delayed HAART (6·40 vs. 5·69 and 5·57 vs. 4·90 years for baseline CD4 ≥500 and 350-499/mm3, respectively). In patients with a baseline HIV viral load ≤3·5 log10 copies/ml, delayed HAART performed better than immediate HAART (6·43 vs. 6·26 and 5·95 vs. 5·18 for baseline CD4 ≥500 and 350-499/mm3, respectively). Immediate HAART is beneficial in patients with a baseline HIV viral load 5 log10 copies/ml, whereas deferred HAART appears to be the best option for patients with CD4 ≥350/mm3 and baseline HIV viral load <3·5 log10 copies/ml.
authors.affiliation: Department of Infectious Diseases, CHU Dijon, and Université de Bourgogne, Dijon, F-21000, France. lionel.piroth@chu-dijon.fr
authors.forename: L
authors.initials: L
authors.lastname: Piroth
authors.forename: I
authors.initials: I
authors.lastname: Fournel
authors.forename: S
authors.initials: S
authors.lastname: Mahy
authors.forename: Y
authors.initials: Y
authors.lastname: Yazdanpanah
authors.forename: D
authors.initials: D
authors.lastname: Rey
authors.forename: C
authors.initials: C
authors.lastname: Rabaud
authors.forename: J P
authors.initials: JP
authors.lastname: Faller
authors.forename: B
authors.initials: B
authors.lastname: Hoen
authors.forename: M
authors.initials: M
authors.lastname: Fardeheb
authors.forename: C
authors.initials: C
authors.lastname: Quantin
authors.forename: P
authors.initials: P
authors.lastname: Chavanet
authors.forename: C
authors.initials: C
authors.lastname: Binquet
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D003198:Computer Simulation; D003663:Decision Trees; D018450:Disease Progression; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D006801:Humans; D008017:Life Expectancy; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents