R. Scott Braithwaite, MD, MSc; Mark S. Roberts, MD, MPP; Chung Chou H. Chang, PhD; Matthew Bidwell Goetz, MD; Cynthia L. Gibert, MD, MSc; Maria C. Rodriguez-Barradas, MD; Steven Shechter, PhD; Andrew Schaefer, PhD; Kimberly Nucifora, MS; Robert Koppenhaver, MS; Amy C. Justice, MD, PhD
Grant Support: By the National Institute of Alcohol Abuse and Alcoholism (grants K23 AA14483-01, 2U10 AA13566).
Potential Financial Conflicts of Interest:Consultancies: M.S. Roberts (Archimedes). Grants received: M.S. Roberts (National Institutes of Health).
Requests for Single Reprints: R. Scott Braithwaite, MD, MSc, Yale University, 950 Campbell Avenue, West Haven, CT 06516; e-mail, Ronald.Braithwaite@va.gov.
Current Author Addresses: Drs. Braithwaite and Justice and Ms. Nucifora: Yale University, 950 Campbell Avenue, West Haven, CT 06516.
Drs. Roberts and Chang: University of Pittsburgh, 200 Meyran Avenue, Pittsburgh, PA 15213.
Dr. Goetz: Veterans Affairs Greater Los Angeles Healthcare System, 11301 Wilshire Boulevard, Los Angeles, CA 90073.
Dr. Gilbert: Veterans Affairs Medical Center, 50 Irving Street NW, Washington, DC 20422.
Dr. Rodriguez-Barradas: Veterans Affairs Medical Center, 2002 Holcombe Boulevard, Houston, TX 77030.
Dr. Shechter: University of British Columbia, 2053 Main Mall, Vancouver, British Columbia V6T172, Canada.
Dr. Schaefer: University of Pittsburgh, 3800 Ottawa Street, Pittsburgh, PA 15261.
Mr. Koppenhaver: University of Pittsburgh, 1048 Benedum Hall, Pittsburgh, PA 15261.
Author Contributions: Conception and design: R.S. Braithwaite, M.S. Roberts, C.L. Gibert, M.C. Rodriguez-Barradas, A. Schaefer, A.C. Justice.
Analysis and interpretation of the data: R.S. Braithwaite, M.S. Roberts, C.C. Chang, M.B. Goetz, C.L. Gibert, M.C. Rodriguez-Barradas, S. Shechter, R. Koppenhaver, A.C. Justice.
Drafting of the article: R.S. Braithwaite, C.C. Chang, C.L. Gibert, A.C. Justice.
Critical revision of the article for important intellectual content: R.S. Braithwaite, M.S. Roberts, M.B. Goetz, C.L. Gibert, M.C. Rodriguez-Barradas, A.C. Justice.
Final approval of the article: R.S. Braithwaite, M.S. Roberts, C.C. Chang, M.B. Goetz, C.L. Gibert, M.C. Rodriguez-Barradas, S. Shechter, A.C. Justice.
Provision of study materials or patients: A.C. Justice.
Statistical expertise: C.C. Chang, R. Koppenhaver, A.C. Justice.
Obtaining of funding: R.S. Braithwaite.
Administrative, technical, or logistic support: K. Nucifora, A.C. Justice.
Collection and assembly of data: K. Nucifora, R. Koppenhaver.
Braithwaite R., Roberts M., Chang C., Goetz M., Gibert C., Rodriguez-Barradas M., Shechter S., Schaefer A., Nucifora K., Koppenhaver R., Justice A.; Influence of Alternative Thresholds for Initiating HIV Treatment on Quality-Adjusted Life Expectancy: A Decision Model. Ann Intern Med. 2008;148:178-185. doi: 10.7326/0003-4819-148-3-200802050-00004
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Published: Ann Intern Med. 2008;148(3):178-185.
The optimal timing for initiating HIV treatment has long been controversial. Soon after combination antiretroviral therapies became available, the prevailing treatment ethos was “hit early, hit hard,” and patients often began receiving therapy immediately after HIV infection was diagnosed (1). However, as it became clear that toxicity and side effects from combination antiretroviral therapy were substantial (2–5) and that early treatment may hasten genotypic resistance (6–8), treatment guidelines increasingly have favored postponing therapy initiation (9, 10). Yet, postponing therapy has disadvantages because it exposes HIV-infected patients to a greater risk for AIDS than is otherwise necessary (9–15) and may impair immune reconstitution (16). Guidelines once again may be in flux, trending toward earlier treatment initiation (17).
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Infectious Disease, HIV.
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