Effect of Immediate Initiation of Antiretroviral Treatment in HIV-Positive Individuals Aged 50 Years or Older

Sara Lodi; Dominique Costagliola; Caroline Sabin; Julia del Amo; Roger Logan; Sophie Abgrall; Peter Reiss; Ard van Sighem; Sophie Jose; Jose-Ramon Blanco; Victoria Hernando; Heiner C. Bucher; Helen Kovari; Ferran Segura; Juan Ambrosioni; Charalambos A. Gogos; Nikos Pantazis; Francois Dabis; Marie-Anne Vandenhende; Laurence Meyer; Rémonie Seng; M. John Gill; Hartmut Krentz; Andrew N. Phillips; Kholoud Porter; Beatriz Grinsztejn; Antonio G. Pacheco; Roberto Muga; Janet Tate; Amy Justice; Miguel A. Hernán

doi:https://doi.org/10.1097/QAI.0000000000001498

Effect of Immediate Initiation of Antiretroviral Treatment in HIV-Positive Individuals Aged 50 Years or Older

Sara Lodi, Dominique Costagliola, Caroline Sabin, Julia del Amo, Roger Logan, Sophie Abgrall, Peter Reiss, Ard van Sighem, Sophie Jose, Jose-Ramon Blanco, Victoria Hernando, Heiner C. Bucher, Helen Kovari, Ferran Segura, Juan Ambrosioni, Charalambos A. Gogos, Nikos Pantazis, Francois Dabis, Marie-Anne Vandenhende, Laurence MeyerRémonie Seng, M. John Gill, Hartmut Krentz, Andrew N. Phillips, Kholoud Porter, Beatriz Grinsztejn, Antonio G. Pacheco, Roberto Muga, Janet Tate, Amy Justice, Miguel A. Hernán

Research output: Contribution to journal › Article › Academic › peer-review

10 Citations (Scopus)

Abstract

Background: Clinical guidelines recommend immediate initiation of combined antiretroviral therapy for all HV-positive individuals. However, those guidelines are based on trials of relatively young participants. Methods: We included HIV-positive antiretroviral therapy-naive, AIDS-free individuals aged 50-70 years after 2004 in the HIV-CAUSAL Collaboration. We used the parametric g-formula to estimate the 5-year risk of all-cause and non-AIDS mortality under (1) immediate initiation at baseline and initiation at CD4 count, (2) <500 cells/mm(3), and (3) <350 cells/mm(3). Results were presented separately for the general HIV population and for a US Veterans cohort with high mortality. Results: The study included 9596 individuals (28% US Veterans) with median (interquantile range) age of 55 (52-60) years and CD4 count of 336 (182-513) at baseline. The 5-year risk of all-cause mortality was 0.40% (95% confidence interval (CI): 0.10 to 0.71) lower for the general HIV population and 1.61% (95% CI: 0.79 to 2.67) lower for US Veterans when comparing immediate initiation vs initiation at CD4 <350 cells/mm(3). The 5-year risk of non-AIDS mortality was 0.17% (95% CI: 20.07 to 0.43) lower for the general HIV population and 1% (95% CI: 0.31 to 2.00) lower for US Veterans when comparing immediate initiation vs initiation at CD4 <350 cells/mm(3). Conclusions: Immediate initiation seems to reduce all-cause and non-AIDS mortality in patients aged 50-70 years

Original language	English
Pages (from-to)	311-318
Journal	JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES
Volume	76
Issue number	3
Early online date	2017
DOIs	https://doi.org/10.1097/QAI.0000000000001498
Publication status	Published - 2017

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https://doi.org/10.1097/QAI.0000000000001498

Cite this

Lodi, S., Costagliola, D., Sabin, C., del Amo, J., Logan, R., Abgrall, S., Reiss, P., van Sighem, A., Jose, S., Blanco, J.-R., Hernando, V., Bucher, H. C., Kovari, H., Segura, F., Ambrosioni, J., Gogos, C. A., Pantazis, N., Dabis, F., Vandenhende, M.-A., ... Hernán, M. A. (2017). Effect of Immediate Initiation of Antiretroviral Treatment in HIV-Positive Individuals Aged 50 Years or Older. JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES, 76(3), 311-318. https://doi.org/10.1097/QAI.0000000000001498

@article{c9590918d20b4376be1b2163b248c418,

title = "Effect of Immediate Initiation of Antiretroviral Treatment in HIV-Positive Individuals Aged 50 Years or Older",

abstract = "Background: Clinical guidelines recommend immediate initiation of combined antiretroviral therapy for all HV-positive individuals. However, those guidelines are based on trials of relatively young participants. Methods: We included HIV-positive antiretroviral therapy-naive, AIDS-free individuals aged 50-70 years after 2004 in the HIV-CAUSAL Collaboration. We used the parametric g-formula to estimate the 5-year risk of all-cause and non-AIDS mortality under (1) immediate initiation at baseline and initiation at CD4 count, (2) <500 cells/mm(3), and (3) <350 cells/mm(3). Results were presented separately for the general HIV population and for a US Veterans cohort with high mortality. Results: The study included 9596 individuals (28% US Veterans) with median (interquantile range) age of 55 (52-60) years and CD4 count of 336 (182-513) at baseline. The 5-year risk of all-cause mortality was 0.40% (95% confidence interval (CI): 0.10 to 0.71) lower for the general HIV population and 1.61% (95% CI: 0.79 to 2.67) lower for US Veterans when comparing immediate initiation vs initiation at CD4 <350 cells/mm(3). The 5-year risk of non-AIDS mortality was 0.17% (95% CI: 20.07 to 0.43) lower for the general HIV population and 1% (95% CI: 0.31 to 2.00) lower for US Veterans when comparing immediate initiation vs initiation at CD4 <350 cells/mm(3). Conclusions: Immediate initiation seems to reduce all-cause and non-AIDS mortality in patients aged 50-70 years",

author = "Sara Lodi and Dominique Costagliola and Caroline Sabin and {del Amo}, Julia and Roger Logan and Sophie Abgrall and Peter Reiss and {van Sighem}, Ard and Sophie Jose and Jose-Ramon Blanco and Victoria Hernando and Bucher, {Heiner C.} and Helen Kovari and Ferran Segura and Juan Ambrosioni and Gogos, {Charalambos A.} and Nikos Pantazis and Francois Dabis and Marie-Anne Vandenhende and Laurence Meyer and R{\'e}monie Seng and Gill, {M. John} and Hartmut Krentz and Phillips, {Andrew N.} and Kholoud Porter and Beatriz Grinsztejn and Pacheco, {Antonio G.} and Roberto Muga and Janet Tate and Amy Justice and Hern{\'a}n, {Miguel A.}",

year = "2017",

doi = "https://doi.org/10.1097/QAI.0000000000001498",

language = "English",

volume = "76",

pages = "311--318",

journal = "JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES",

issn = "1525-4135",

publisher = "Lippincott Williams and Wilkins",

number = "3",

}

Lodi, S, Costagliola, D, Sabin, C, del Amo, J, Logan, R, Abgrall, S, Reiss, P, van Sighem, A, Jose, S, Blanco, J-R, Hernando, V, Bucher, HC, Kovari, H, Segura, F, Ambrosioni, J, Gogos, CA, Pantazis, N, Dabis, F, Vandenhende, M-A, Meyer, L, Seng, R, Gill, MJ, Krentz, H, Phillips, AN, Porter, K, Grinsztejn, B, Pacheco, AG, Muga, R, Tate, J, Justice, A & Hernán, MA 2017, 'Effect of Immediate Initiation of Antiretroviral Treatment in HIV-Positive Individuals Aged 50 Years or Older', JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES, vol. 76, no. 3, pp. 311-318. https://doi.org/10.1097/QAI.0000000000001498

TY - JOUR

T1 - Effect of Immediate Initiation of Antiretroviral Treatment in HIV-Positive Individuals Aged 50 Years or Older

AU - Lodi, Sara

AU - Costagliola, Dominique

AU - Sabin, Caroline

AU - del Amo, Julia

AU - Logan, Roger

AU - Abgrall, Sophie

AU - Reiss, Peter

AU - van Sighem, Ard

AU - Jose, Sophie

AU - Blanco, Jose-Ramon

AU - Hernando, Victoria

AU - Bucher, Heiner C.

AU - Kovari, Helen

AU - Segura, Ferran

AU - Ambrosioni, Juan

AU - Gogos, Charalambos A.

AU - Pantazis, Nikos

AU - Dabis, Francois

AU - Vandenhende, Marie-Anne

AU - Meyer, Laurence

AU - Seng, Rémonie

AU - Gill, M. John

AU - Krentz, Hartmut

AU - Phillips, Andrew N.

AU - Porter, Kholoud

AU - Grinsztejn, Beatriz

AU - Pacheco, Antonio G.

AU - Muga, Roberto

AU - Tate, Janet

AU - Justice, Amy

AU - Hernán, Miguel A.

PY - 2017

Y1 - 2017

N2 - Background: Clinical guidelines recommend immediate initiation of combined antiretroviral therapy for all HV-positive individuals. However, those guidelines are based on trials of relatively young participants. Methods: We included HIV-positive antiretroviral therapy-naive, AIDS-free individuals aged 50-70 years after 2004 in the HIV-CAUSAL Collaboration. We used the parametric g-formula to estimate the 5-year risk of all-cause and non-AIDS mortality under (1) immediate initiation at baseline and initiation at CD4 count, (2) <500 cells/mm(3), and (3) <350 cells/mm(3). Results were presented separately for the general HIV population and for a US Veterans cohort with high mortality. Results: The study included 9596 individuals (28% US Veterans) with median (interquantile range) age of 55 (52-60) years and CD4 count of 336 (182-513) at baseline. The 5-year risk of all-cause mortality was 0.40% (95% confidence interval (CI): 0.10 to 0.71) lower for the general HIV population and 1.61% (95% CI: 0.79 to 2.67) lower for US Veterans when comparing immediate initiation vs initiation at CD4 <350 cells/mm(3). The 5-year risk of non-AIDS mortality was 0.17% (95% CI: 20.07 to 0.43) lower for the general HIV population and 1% (95% CI: 0.31 to 2.00) lower for US Veterans when comparing immediate initiation vs initiation at CD4 <350 cells/mm(3). Conclusions: Immediate initiation seems to reduce all-cause and non-AIDS mortality in patients aged 50-70 years

AB - Background: Clinical guidelines recommend immediate initiation of combined antiretroviral therapy for all HV-positive individuals. However, those guidelines are based on trials of relatively young participants. Methods: We included HIV-positive antiretroviral therapy-naive, AIDS-free individuals aged 50-70 years after 2004 in the HIV-CAUSAL Collaboration. We used the parametric g-formula to estimate the 5-year risk of all-cause and non-AIDS mortality under (1) immediate initiation at baseline and initiation at CD4 count, (2) <500 cells/mm(3), and (3) <350 cells/mm(3). Results were presented separately for the general HIV population and for a US Veterans cohort with high mortality. Results: The study included 9596 individuals (28% US Veterans) with median (interquantile range) age of 55 (52-60) years and CD4 count of 336 (182-513) at baseline. The 5-year risk of all-cause mortality was 0.40% (95% confidence interval (CI): 0.10 to 0.71) lower for the general HIV population and 1.61% (95% CI: 0.79 to 2.67) lower for US Veterans when comparing immediate initiation vs initiation at CD4 <350 cells/mm(3). The 5-year risk of non-AIDS mortality was 0.17% (95% CI: 20.07 to 0.43) lower for the general HIV population and 1% (95% CI: 0.31 to 2.00) lower for US Veterans when comparing immediate initiation vs initiation at CD4 <350 cells/mm(3). Conclusions: Immediate initiation seems to reduce all-cause and non-AIDS mortality in patients aged 50-70 years

U2 - https://doi.org/10.1097/QAI.0000000000001498

DO - https://doi.org/10.1097/QAI.0000000000001498

M3 - Article

C2 - 28746165

SN - 1525-4135

VL - 76

SP - 311

EP - 318

JO - JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES

JF - JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES

IS - 3

ER -