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The Prognostic Importance of Changes in CD4+Cell Count and HIV-1 RNA Level in Women after Initiating Highly Active Antiretroviral Therapy

Kathryn Anastos, MD; Yolanda Barrón, MS; Mardge H. Cohen, MD; Ruth M. Greenblatt, MD; Howard Minkoff, MD; Alexandra Levine, MD; Mary Young, MD; and Stephen J. Gange, PhD
[+] Article and Author Information

From Montefiore Medical Center and Lincoln Medical and Mental Health Center, Bronx, New York; Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Cook County Hospital, Chicago, Illinois; University of California, San Francisco, San Francisco, California; Health Science Center at Brooklyn, Brooklyn, New York; University of Southern California, Los Angeles, California; and Georgetown University Medical Center, Washington, DC.


Grant Support: The WIHS is funded by the National Institute of Allergy and Infectious Diseases with supplemental funding from the National Cancer Institute, the National Institute on Drug Abuse, and the National Institute of Dental Research (grants U01-AI-35004, U01-AI-31834, U01-AI-34994, U01-AI-34989, U01-AI-34993, and U01-AI-42590). Funding was also provided by the National Institute of Child Health and Human Development (grant U01-HD-32632) and the National Center for Research Resources (grants M01-RR-00071, M01-RR-00079, and M01-RR00083).

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Kathryn Anastos, MD, Women's Interagency HIV Study, 3311 Bainbridge Avenue, Second Floor, Bronx, NY 10467; e-mail, kanastos@verizon.net.

Current Author Addresses: Dr. Anastos: WIHS, Montefiore Medical Center, 3311 Bainbridge Avenue, Bronx, NY 10467.

Ms. Barrón: Department of Epidemiology, Johns Hopkins University Bloomberg School of Public of Health, 615 North Wolfe Street/Room E7012, Baltimore, MD 21205.

Dr. Cohen: Core Center, Cook County Bureau of Health Services, 2020 W. Harrison, Chicago, IL 60612.

Dr. Greenblatt: Infectious Diseases Division, Box 1352, University of California, San Francisco, San Francisco, CA 94143-1352.

Dr. Minkoff: Maimonides Medical Center, 967 48th Street, Brooklyn, NY 11219.

Dr. Levine: Division of Hematology, USC/Norris Cancer Hospital, 1441 Eastlake Avenue, Room 3468, Los Angeles, CA 90033.

Dr. Young: Georgetown University Medical Center, 110 Kober-Cogan Building, 3800 Reservoir Road, NW, Washington, DC 20007.

Dr. Gange: Amgen Inc., One Amgen Center Drive, Thousand Oaks, CA 91320-1799.

Author Contributions: Conception and design: K. Anastos, M.H. Cohen, R.M. Greenblatt, A. Levine, S.J. Gange.

Analysis and interpretation of the data: K. Anastos, Y. Barrón, M.H. Cohen, S.J. Gange.

Drafting of the article: K. Anastos, Y. Barrón, R.M. Greenblatt, A. Levine, S.J. Gange.

Critical revision of the article for important intellectual content: K. Anastos, Y. Barrón, M.H. Cohen, R.M. Greenblatt, H. Minkoff, A. Levine, M. Young, S.J. Gange.

Final approval of the article: K. Anastos, Y. Barrón, M.H. Cohen, R.M. Greenblatt, H. Minkoff, A. Levine, M. Young, S.J. Gange.

Provision of the study materials or patients: K. Anastos, M.H. Cohen, R.M. Greenblatt, H. Minkoff, A. Levine, M. Young.

Statistical expertise: Y. Barrón, S.J. Gange.

Obtaining of funding: K. Anastos, M.H. Cohen, R.M. Greenblatt, H. Minkoff, A. Levine, M. Young, S.J. Gange.

Administrative, technical, or logistic support: K. Anastos.

Collection and assembly of the data: K. Anastos, M.H. Cohen, R.M. Greenblatt, S.J. Gange.


Ann Intern Med. 2004;140(4):256-264. doi:10.7326/0003-4819-140-4-200402170-00007
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Of the 2059 women with HIV-1 infection who had the infection at the time of WIHS enrollment and the 9 women who acquired HIV infection during the WIHS follow-up period, 1132 initiated HAART between July 1995 and 30 September 2001, had a HAART initiation date known within 1 year, and contributed some follow-up time after HAART initiation. The median follow-up was 3.9 years (interquartile range, 2.5 to 4.8 years). Only 77 (6.8%) of the 1132 included women were lost to follow-up (excluding deaths). Table 1 shows the demographic and baseline clinical characteristics of the included women. The median CD4+ cell count was lower (0.202 × 109 cells/L vs. 0.318 × 109 cells/L; P< 0.001 [Wilcoxon rank-sum test]), and the median HIV-1 RNA level was higher (23 500 copies/mL vs. 9300 copies/mL; P< 0.001 [Wilcoxon rank-sum test]) in 552 women initiating HAART after reporting an AIDS-defining illness compared with 580 women who had not reported a previous AIDS-defining illness.

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Figures

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Figure 1.
Mean CD4 + cell count after highly active antiretroviral therapy (HAART) initiation, stratified by CD4 + count before HAART initiation.+

Points represent mean CD4 cell counts at semiannual study visits.

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Figure 2.
Kaplan–Meier estimates of the proportion of women with CD4 + cell counts of less than 0.200 × 10 9 cells/L (top) and less than 0.350 × 10 9 cells/L (bottom) after highly active antiretroviral therapy (HAART) initiation.+9

Eighty women initiating HAART with CD4 cell counts < 0.200 × 10 cells/L died during the study period.

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Summary for Patients

The Relationship of Pre- and Post-Treatment Laboratory Tests with Outcomes for Women Starting Treatment for HIV Infection

The summary below is from the full report titled “The Prognostic Importance of Changes in CD4+Cell Count and HIV-1 RNA Level in Women after Initiating Highly Active Antiretroviral Therapy.” It is in the 17 February 2004 issue of Annals of Internal Medicine (volume 140, pages 256-264). The authors are K. Anastos, Y. Barrón, M.H. Cohen, R.M. Greenblatt, H. Minkoff, A. Levine, M. Young, and S.J. Gange.

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