title: Survival outcomes and effect of early vs. deferred cART among HIV-infected patients diagnosed at the time of an AIDS-defining event: a cohort analysis.
abstract: OBJECTIVE
  We analyzed clinical progression among persons diagnosed with HIV at the time of an AIDS-defining event, and assessed the impact on outcome of timing of combined antiretroviral treatment (cART).
  
  
  METHODS
  Retrospective, European and Canadian multicohort study.. Patients were diagnosed with HIV from 1997-2004 and had clinical AIDS from 30 days before to 14 days after diagnosis. Clinical progression (new AIDS event, death) was described using Kaplan-Meier analysis stratifying by type of AIDS event. Factors associated with progression were identified with multivariable Cox regression. Progression rates were compared between those starting early (<30 days after AIDS event) or deferred (30-270 days after AIDS event) cART.
  
  
  RESULTS
  The median (interquartile range) CD4 count and viral load (VL) at diagnosis of the 584 patients were 42 (16, 119) cells/µL and 5.2 (4.5, 5.7) log(10) copies/mL. Clinical progression was observed in 165 (28.3%) patients. Older age, a higher VL at diagnosis, and a diagnosis of non-Hodgkin lymphoma (NHL) (vs. other AIDS events) were independently associated with disease progression. Of 366 patients with an opportunistic infection, 178 (48.6%) received early cART. There was no significant difference in clinical progression between those initiating cART early and those deferring treatment (adjusted hazard ratio 1.32 [95% confidence interval 0.87, 2.00], p = 0.20).
  
  
  CONCLUSIONS
  Older patients and patients with high VL or NHL at diagnosis had a worse outcome. Our data suggest that earlier initiation of cART may be beneficial among HIV-infected patients diagnosed with clinical AIDS in our setting.
authors: Hospital Cliníc-IDIBAPS, University of Barcelona, Barcelona, Spain.
authors: Jose M
authors: JM
authors: Miro
authors: Christian
authors: C
authors: Manzardo
authors: Cristina
authors: C
authors: Mussini
authors: Margaret
authors: M
authors: Johnson
authors: Antonella
authors: A
authors: d'Arminio Monforte
authors: Andrea
authors: A
authors: Antinori
authors: M John
authors: MJ
authors: Gill
authors: Laura
authors: L
authors: Sighinolfi
authors: Caterina
authors: C
authors: Uberti-Foppa
authors: Vanni
authors: V
authors: Borghi
authors: Caroline
authors: C
authors: Sabin
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000150:complications / Q000188:drug therapy; D000328:Adult; D044966:Anti-Retroviral Agents / Q000494:pharmacology* / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D002170:Canada; D015331:Cohort Studies; D018450:Disease Progression; D005060:Europe; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors
chemical_list: D044966:Anti-Retroviral Agents