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- Title
A decision tree to help determine the best timing and antiretroviral strategy in HIV-infected patients.
- Authors
PIROTH, L.; FOURNEL, I.; MAHY, S.; YAZDANPANAH, Y.; REY, D.; RABAUD, C.; FALLER, J. P.; HOEN, B.; FARDEHEB, M.; QUANTIN, C.; CHAVANET, P.; BINQUET, C.
- Abstract
Optimal antiretroviral strategies for HIV-infected patients still need to be established. To this end a decision tree including different antiretroviral strategies that could be adopted for HIV-infected patients was built. A 10-year follow-up was simulated by using transitional probabilities estimated from a large cohort using a time-homogeneous Markov model. The desired outcome was for patients to maintain a CD4 cell count of >500 cells/mm3 without experiencing AIDS or death. For patients with a baseline HIV viral load ⩾5 log10 copies/ml, boosted protease inhibitor-based immediate highly active antiretroviral therapy (HAART) allowed them to spend 12% more time with CD4 ⩾500/mm3 than did delayed HAART (6·40 vs. 5·69 and 5·57 vs. 4·90 years for baseline CD4 ⩾500 and 350–499/mm3, respectively). In patients with a baseline HIV viral load ⩽3·5 log10 copies/ml, delayed HAART performed better than immediate HAART (6·43 vs. 6·26 and 5·95 vs. 5·18 for baseline CD4 ⩾500 and 350–499/mm3, respectively). Immediate HAART is beneficial in patients with a baseline HIV viral load ⩾5 log10 copies/ml, whereas deferred HAART appears to be the best option for patients with CD4 ⩾350/mm3 and baseline HIV viral load <3·5 log10 copies/ml.
- Subjects
ANTIRETROVIRAL agents; HIV-positive persons; DECISION trees; MARKOV processes; AIDS; PROTEASE inhibitors; HIGHLY active antiretroviral therapy; VIRAL load
- Publication
Epidemiology & Infection, 2011, Vol 139, Issue 12, p1835
- ISSN
0950-2688
- Publication type
Article
- DOI
10.1017/S0950268810002980