Portal de Periódicos da CAPES

Inferior Clinical Outcome of the CD4+ Cell Count–Guided Antiretroviral Treatment Interruption Strategy in the SMART Study: Role of CD4+ Cell Counts and HIV RNA Levels during Follow-up

2008; Oxford University Press; Volume: 197; Issue: 8 Linguagem: Inglês

10.1086/529523

1537-6613

Jens Lundgren, Abdel Babiker, Wafaa El‐Sadr, Sean Emery, Birgit Grund, James D. Neaton, Jacquie Neuhaus, Andrew Phillips,

HIV/AIDS Research and Interventions

The SMART study compared 2 strategies for using antiretroviral therapy-drug conservation (DC) and viral suppression (VS)-in 5,472 human immunodeficiency virus (HIV)-infected patients with CD4+ cell counts >350 cells/microL. Rates and predictors of opportunistic disease or death (OD/death) and the relative risk (RR) in DC versus VS groups according to the latest CD4+ cell count and HIV RNA level are reported.During a mean of 16 months of follow-up, DC patients spent more time with a latest CD4+ cell count 400 copies/mL (71% vs. 28%) and had a higher rate of OD/death (3.4 vs. 1.3/100 person-years) than VS patients. For periods of follow- up with a CD4+ cell count or= 350 cells/microL-an increase explained by the higher HIV RNA levels in the DC group.The higher risk of OD/death in DC patients was associated with (1) spending more follow-up time with relative immunodeficiency and (2) living longer with uncontrolled HIV replication even at higher CD4+ cell counts. Ongoing HIV replication at a given CD4+ cell count places patients at an excess risk of OD/death.