Antiretroviral Therapy for Asymptomatic Adults and Adolescents with HIV-1 Infection and CD4+ T-cell Counts ≥500 cells/μL: a Meta-Analysis.
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Authors
Anglemyer, Andrew T.
Rutherford, George
Horvath, Hacsi
Vitoria, Marco
Doherty, Margaret
Subjects
HIV
antiretroviral therapy
practice guidelines
World Health Organization
antiretroviral therapy
practice guidelines
World Health Organization
Advisors
Date of Issue
2018
Date
Publisher
ARC
Language
Abstract
Background: World Health Organization (WHO) antiretroviral therapy (ART) guidelines are regularly updated with the most current evidence on when to initiate ART. Methods: We performed a systematic review and meta-analysis and identified published literature and
conference abstracts for randomised controlled trials (RCT) and cohort studies that compared HIV-infected
patients starting ART at ≥ 500 CD4 cells/µL with those with <500 CD4 cells/µL. Results: We identified 24 articles. Studies found a decreased hazard of HIV disease progression with
initiation at >500 CD4 cells/µL (2 RCTs: relative risk [RR]=0·38, 95% CI 0·20-0·74; 1 cohort: hazard ratio
[HR]=0·20, 95% CI 0·10-0·42). One RCT found a reduced risk of HIV transmission (RR=0·11, 95% CI 0·06-
0·19), although this was not supported in two cohorts (RR=1·17, 95% CI 0·46-2·98). There was no increased
risk of most Grade 3/4 adverse events identified in RCTs, but there was evidence of increased risk of
laboratory adverse events for earlier initiation (RR=1·43; 95% CI 1·13-1·81) from one cohort study. Conclusion: We found moderate quality evidence that the ART initiation at CD4 ≥500 cells/µL leads to
reduced risk of disease progression. The risk of adverse events for early initiators is not yet well understood
and needs further investigation.
Type
Article
Description
The article of record as published may be found at http://dx.doi.org/10.
Series/Report No
Department
Operations Research (OR)
Organization
Naval Postgraduate School (U.S.)
Identifiers
NPS Report Number
Sponsors
Funder
Format
16 p.
Citation
Andrew Anglemyer, George Rutherford, Hacsi Horvath, Marco Vitoria, Margaret Doherty Antiretroviral Therapy for Asymptomatic Adults and Adolescents with HIV-1 Infection and CD4+ T-Cell Counts ≥500 Cells/ΜI: A Systematic Review and Meta-Analysis. ARC Journal of AIDS: 38–53.
Distribution Statement
Rights
This publication is a work of the U.S. Government as defined in Title 17, United States Code, Section 101. Copyright protection is not available for this work in the United States.