Evan Wood, PhD; Robert S. Hogg, PhD; Benita Yip, BSc (Pharm); P. Richard Harrigan, PhD; Michael V. O'Shaughnessy, PhD; Julio S.G. Montaner, MD, FRCPC
Acknowledgments: The authors thank Bonnie Devlin, Elizabeth Ferris, Nada Gataric, Kelly Hsu, Myrna Reginaldo, Chandra Lips, and Peter Vann for their research and administrative assistance and Kathy Li, Kevin Craib, and Martin Schechter for their advice on the statistical methods.
Grant Support: Evan Wood is supported by the Michael Smith Foundation for Health Research. Robert Hogg is supported by the Michael Smith Foundation for Health Research through a Career Investigator Award and by Canadian Institutes of Health Research through an Investigator Award.
Potential Financial Conflicts of Interest:Honoraria: R.S. Hogg (AIDS Research Program, St. Paul's Hospital); Grants received: J.S.G. Montaner (Abbott Laboratories, Agouron Pharmaceuticals, Shire Biochem, Boehringer Ingelheim Pharmaceuticals, Belgium International GmbH, Bristol-Myers Squibb, DuPont Pharma, Gilead Sciences, Glaxo Wellcome, Hoffman-LaRoche, Kucera Pharmaceutical Co., Merck Frosst Laboratories, Pharmacia & Upjohn, Trimeris); Patents received: J.S.G. Montaner (PCT/EP 02/.05151: Co-inventor, along with Boehringer Ingelheim International GmbH, of “Use of nevirapine to treat or prevent lipid abnormalities in patients with HIV that is resistant to nevirapine”); Patents pending: J.S.G. Montaner (PCT/CA02/00796: “Pharmacological applications of mitochondrial DNA assays,” filed 29 May 2002; U.S. patent application for “Pharmacological applications of mitochondrial DNA analysis,” filed 29 May 2002; U.S. provincial application for “Sepsis”).
Requests for Single Reprints: Julio S.G. Montaner, MD, FRCPC, AIDS Research Program, University of British Columbia/St. Paul's Hospital, 667-1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6, Canada; e-mail, email@example.com.
Current Author Addresses: Drs. Wood, Hogg, Harrigan, O'Shaughnessy, and Montaner and Ms. Yip: University of British Columbia/St. Paul's Hospital, 667-1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6, Canada.
Author Contributions: Conception and design: E. Wood, R.S. Hogg, B. Yip, J.S.G. Montaner.
Analysis and interpretation of the data: E. Wood, R.S. Hogg, B. Yip, J.S.G. Montaner.
Drafting of the article: E. Wood, R.S. Hogg, B. Yip, P.H. Harrigan, J.S.G. Montaner.
Critical revision of the article for important intellectual content: E. Wood, R.S. Hogg, B. Yip, P.H. Harrigan, M.V. O'Shaughnessy, J.S.G. Montaner.
Final approval of the article: E. Wood, R.S. Hogg, M.V. O'Shaughnessy, J.S.G. Montaner.
Statistical expertise: E. Wood, M.V. O'Shaughnessy.
Obtaining of funding: R.S. Hogg, M.V. O'Shaughnessy, J.S.G. Montaner.
Administrative, technical, or logistic support: E. Wood, R.S. Hogg, B. Yip, P.H. Harrigan, M.V. O'Shaughnessy, J.S.G. Montaner.
Collection and assembly of data: B. Yip.
Wood E, Hogg RS, Yip B, Harrigan PR, O'Shaughnessy MV, Montaner JS. Effect of Medication Adherence on Survival of HIV-Infected Adults Who Start Highly Active Antiretroviral Therapy When the CD4+ Cell Count Is 0.200 to 0.350 × 109 cells/L. Ann Intern Med. 2003;139:810-816. doi: 10.7326/0003-4819-139-10-200311180-00008
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Published: Ann Intern Med. 2003;139(10):810-816.
The benefits of highly active antiretroviral therapy (HAART) in the management of HIV disease are well established. By suppressing plasma HIV-1 RNA, HAART decreases morbidity and mortality in HIV-infected patients (1, 2). However, the optimal time to initiate HAART is uncertain. As a result, expert recommendations on the optimal time to initiate antiretroviral therapy widely differ (3-6).
Several studies have suggested that only patients who initiated therapy when the CD4+ cell count had declined below 0.200 × 109 cells/L were at increased risk for disease progression, regardless of the baseline HIV RNA level (7-9). In 1 of these studies, further examination with additional duration of follow-up suggested that mortality may be elevated in patients who initiated therapy after the CD4+ cell count declined below 0.350 × 109 cells/L (10). In fact, a growing number of studies have suggested that delaying HAART after the CD4+ cell count declines below 0.350 × 109 cells/L may be unsafe (11-14).
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Infectious Disease, HIV.
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