Frank J. Palella, MD; Maria Deloria-Knoll, PhD; Joan S. Chmiel, PhD; Anne C. Moorman, BSN, MPH; Kathleen C. Wood, BSN; Alan E. Greenberg, MD, MPH; Scott D. Holmberg, MD, MPH; the HIV Outpatient Study (HOPS) Investigators*
Acknowledgment: The authors thank John P. Phair, MD, Professor Emeritus of Medicine, The Feinberg School of Medicine, Northwestern University, for his ongoing support, insight, and sage advice.
Grant Support: By the Centers for Disease Control and Prevention (contract 200-2001-00133), Atlanta, Georgia.
Potential Financial Conflicts of Interest: None disclosed.
Requests for Single Reprints: Frank J. Palella Jr., MD, Division of Infectious Diseases, The Feinberg School of Medicine, Northwestern University, 676 North Saint Clair, Suite 200, Chicago, IL 60611; e-mail, firstname.lastname@example.org.
Current Author Addresses: Dr. Palella: Division of Infectious Diseases, The Feinberg School of Medicine, Northwestern University, 676 North Saint Clair, Suite 200, Chicago, IL 60611.
Drs. Deloria-Knoll and Chmiel: Department of Preventive Medicine, The Feinberg School of Medicine, Northwestern University, 680 North Lake Shore Drive, Suite 1102, Chicago, IL 60611.
Ms. Moorman, Dr. Greenberg, and Dr. Holmberg: Centers for Disease Control and Prevention, Mailstop E-45, 1600 Clifton Road, Atlanta, GA 30333.
Ms. Wood: Cerner Corporation, 2800 Rockcreek Parkway, Kansas City, MO 64117.
Author Contributions: Conception and design: F.J. Palella, M. Deloria-Knoll, J.S. Chmiel, A.C. Moorman, S.D. Holmberg.
Analysis and interpretation of the data: F.J. Palella, M. Deloria-Knoll, J.S. Chmiel, A.C. Moorman, A.E. Greenberg, S.D. Holmberg.
Drafting of the article: F.J. Palella.
Critical revision of the article for important intellectual content: F.J. Palella, M. Deloria-Knoll, J.S. Chmiel, A.C. Moorman, A.E. Greenberg, S.D. Holmberg.
Final approval of the article: F.J. Palella, M. Deloria-Knoll, J.S. Chmiel, A.C. Moorman, K.C. Wood, A.E. Greenberg, S.D. Holmberg.
Provision of study materials or patients: F.J. Palella.
Statistical expertise: M. Deloria-Knoll, J.S. Chmiel.
Obtaining of funding: K.C. Wood.
Administrative, technical, or logistic support: F.J. Palella, A.C. Moorman, K.C. Wood, S.D. Holmberg.
Collection and assembly of data: F.J. Palella, A.C. Moorman, K.C. Wood, S.D. Holmberg.
Palella F., Deloria-Knoll M., Chmiel J., Moorman A., Wood K., Greenberg A., Holmberg S., ; Survival Benefit of Initiating Antiretroviral Therapy in HIV-Infected Persons in Different CD4+ Cell Strata. Ann Intern Med. 2003;138:620-626. doi: 10.7326/0003-4819-138-8-200304150-00007
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Published: Ann Intern Med. 2003;138(8):620-626.
Optimal timing of antiretroviral therapy (ART) initiation for persons with HIV infection is of great clinical and public health importance. Therapy reduces HIV-related mortality and morbidity for patients with substantial CD4+ cell depletion (<0.100 × 109 cells/L) who initiate treatment (1). Although data demonstrate the viral suppressive and immunologic (CD4+ cell count) benefits of therapy in persons with higher CD4+ cell counts (2-8), long-term improvements in disease-associated morbidity and mortality with earlier therapy are less clear (9, 10). In such patients, the potential benefits of ART and highly active ART (HAART) will probably be weighed against possible untoward sequelae of earlier treatment, including the development of metabolic abnormalities; emergence of drug-resistant virus, with resultant exhaustion of effective remaining therapies; cost; and access (9, 11-13). Current treatment guidelines allowing for the delay of ART until a lower CD4+ threshold—usually 0.350 × 109 cells/L or, for some patients, 0.200 × 109 cells/L—reflect a lack of consensus on the benefits of earlier initiation of therapy (13, 14).
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Infectious Disease, HIV.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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