title: Optimal timing for initiation of highly active antiretroviral therapy in treatment-naïve human immunodeficiency virus-1-infected individuals presenting with AIDS-defining diseases: the experience of the PISCIS Cohort.
abstract: In this prospective, multicentre cohort study, we analysed specific prognostic factors and the impact of timing of highly active antiretroviral therapy (HAART) on disease progression and death among 625 human immunodeficiency virus (HIV)-1-infected, treatment-naïve patients diagnosed with an AIDS-defining disease. HAART was classified as early (<30 days) or late (30-270 days). Deferring HAART was significantly associated with faster progression to a new AIDS-defining event/death overall (p 0.009) and in patients with Pneumocystis jiroveci pneumonia (p 0.017). In the multivariate analysis, deferring HAART was associated with a higher risk of a new AIDS-defining event/death (p 0.002; hazard ratio 1.83; 95% CI 1.25-2.68). Other independent risk factors for poorer outcome were baseline diagnosis of AIDS-defining lymphoma, age >35 years, and low CD4(+) count (<50 cells/μL).
authors.affiliation: Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Manzardo
authors.forename: A
authors.initials: A
authors.lastname: Esteve
authors.forename: N
authors.initials: N
authors.lastname: Ortega
authors.forename: D
authors.initials: D
authors.lastname: Podzamczer
authors.forename: J
authors.initials: J
authors.lastname: Murillas
authors.forename: F
authors.initials: F
authors.lastname: Segura
authors.forename: L
authors.initials: L
authors.lastname: Force
authors.forename: C
authors.initials: C
authors.lastname: Tural
authors.forename: J
authors.initials: J
authors.lastname: Vilaró
authors.forename: A
authors.initials: A
authors.lastname: Masabeu
authors.forename: I
authors.initials: I
authors.lastname: Garcia
authors.forename: M
authors.initials: M
authors.lastname: Guadarrama
authors.forename: E
authors.initials: E
authors.lastname: Ferrer
authors.forename: M
authors.initials: M
authors.lastname: Riera
authors.forename: G
authors.initials: G
authors.lastname: Navarro
authors.forename: B
authors.initials: B
authors.lastname: Clotet
authors.forename: J M
authors.initials: JM
authors.lastname: Gatell
authors.forename: J
authors.initials: J
authors.lastname: Casabona
authors.forename: J M
authors.initials: JM
authors.lastname: Miró
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology / Q000401:mortality; D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy* / Q000401:mortality / Q000821:virology; D000293:Adolescent; D000328:Adult; D044966:Anti-Retroviral Agents / Q000008:administration & dosage*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D015497:HIV-1 / Q000302:isolation & purification; D006801:Humans; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D011379:Prognosis; D011446:Prospective Studies; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents