title: [Effectiveness of combined antiretroviral therapy on multiple AIDS-defining illnesses in an HIV seroconverter cohort].
abstract: BACKGROUND
  Several observational studies support the protective effect of combined antiretroviral therapy (cART) on time to first AIDS-defining event, but the effect on multiple AIDS defining illnesses remains unclear.The aim of this study is to analyse whether the protective effect of cART persists beyond the first AIDS-defining illness.
  
  
  METHODS
  A total of 1938 subjects from GEMES seroconverter cohort have been included. To analyse cART effectiveness, calendar time has been divided into three periods according to antiretroviral availability. A population-averaged proportional hazard model with staggered entries that counted the gap time, and had event-specific baseline risks, was fitted.
  
  
  RESULTS
  During follow-up, 1524 (78.6%), 259 (13.4%), 83 (4.3%) and 72 (3.7%) subjects incurred 0, 1, 2, and 3 or more AIDS-defining illnesses, respectively. After adjustment for sex, age at seroconversion and exposure category, the Relative Risk (RR) of AIDS in the cART period was 0.38 (95%CI 0.30-0.48) compared with the 1992-95 period. The RR of the first, second and third AIDS-defining illness in the cART period were 0.40 (95% CI: 0.32-0.50), 0.27 (95% CI: 0.15-0.50) and 0.41 (95% CI: 0.18-0.96) respectively, relative to the reference calendar period when we allowed the odds ratios to vary by the number of prior AIDS-defining events. The relative risk of AIDS, taking all events into account, was 0.32 (95% CI: 0.25-0.40). Intravenous drug users have a higher risk of developing a first episode of AIDS than homosexuals, RR: 2.14 (95% CI: 1.48-3.10).
  
  
  CONCLUSIONS
  Results indicate that the relative effect of cART appears to be both protective and stable over multiple AIDS-defining illnesses. Analysis of multiple AIDS-defining illnesses improves the precision of the estimated relative risk.
authors.affiliation: Centro Superior de Investigación en Salud Pública, Valencia, España. ferreros_inm@gva.es
authors.forename: Inmaculada
authors.initials: I
authors.lastname: Ferreros
authors.forename: Isabel
authors.initials: I
authors.lastname: Hurtado
authors.forename: Julia
authors.initials: J
authors.lastname: del Amo
authors.forename: Roberto
authors.initials: R
authors.lastname: Muga
authors.forename: Jorge
authors.initials: J
authors.lastname: del Romero
authors.forename: Patricia
authors.initials: P
authors.lastname: García
authors.forename: Ignacio
authors.initials: I
authors.lastname: Alastrué
authors.forename: Josefina
authors.initials: J
authors.lastname: Belda
authors.forename: Marcela
authors.initials: M
authors.lastname: Guevara
authors.forename: Santiago
authors.initials: S
authors.lastname: Pérez
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology* / Q000517:prevention & control; D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control*; D000328:Adult; D019380:Anti-HIV Agents / Q000494:pharmacology / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D015331:Cohort Studies; D015897:Comorbidity; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006679:HIV Seropositivity / Q000188:drug therapy*; D006801:Humans; D015994:Incidence; D008297:Male; D016016:Proportional Hazards Models; D012306:Risk; D013030:Spain / Q000453:epidemiology; D015819:Substance Abuse, Intravenous / Q000453:epidemiology; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents