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Gras, L.; Sighem, A. van; Bezemer, D.; Smit, C.; Wit, F.; Wolf, F. de; ATHENA Natl Observational Cohort S (2011)

Lower mortality and earlier start of combination antiretroviral therapy in patients tested repeatedly for HIV than in those with a positive first test

Article / Letter to editor
Background: Early diagnosis of HIV-1 infection will probably beneficially impact onward transmission and life expectancy. We compared mortality rates and CD4 cell counts at start of combination antiretroviral therapy (cART) in patients with different frequencies of diagnostic testing for HIV. Methods: Patients infected with HIV-1 through sexual contact and in follow-up anytime from 2004 through 2008 were selected from the AIDS Therapy Evaluation in the Netherlands national observational HIV cohort and stratified into three groups: patients without a prior negative HIV antibody test (i.e., with a positive first-test result); patients with 1-2 years between the last negative and first positive test; and patients with less than 1 year between tests. Outcome measures were mortality from 2004 through 2008 and CD4 cell count at cART initiation. Results: Of 5494 patients, the mortality rate was highest among the 4067 patients with a positive first test (1.33/100 person-years) and the...Show moreBackground: Early diagnosis of HIV-1 infection will probably beneficially impact onward transmission and life expectancy. We compared mortality rates and CD4 cell counts at start of combination antiretroviral therapy (cART) in patients with different frequencies of diagnostic testing for HIV. Methods: Patients infected with HIV-1 through sexual contact and in follow-up anytime from 2004 through 2008 were selected from the AIDS Therapy Evaluation in the Netherlands national observational HIV cohort and stratified into three groups: patients without a prior negative HIV antibody test (i.e., with a positive first-test result); patients with 1-2 years between the last negative and first positive test; and patients with less than 1 year between tests. Outcome measures were mortality from 2004 through 2008 and CD4 cell count at cART initiation. Results: Of 5494 patients, the mortality rate was highest among the 4067 patients with a positive first test (1.33/100 person-years) and the adjusted relative risk of mortality was 0.50 in 561 patients with tests 1-2 years apart (P = 0.04 compared to patients with a positive first test) and 0.49 (P = 0.02) when tests were less than 1 year apart (n = 866). In patients with a positive first test, 48% had CD4 cell counts less than 200 cells/mu l at cART initiation; this proportion was 23-26% in the two groups of repeatedly tested patients (adjusted odds ratio compared to patients with a positive first test 0.43 and 0.37, respectively; both P < 0.0001). Conclusion: Frequent repeated testing for HIV may improve the rate of timely diagnosis and treatment, thereby preventing disease progression. (c) 2011 Wolters Kluwer Health | Lippincott Williams & WilkinsShow less
combination antiretroviral therapy CD4 cell count disease progression HIV screening transmission health-care settings collaborative analysis life expectancy infection initiation cohort recommendations individuals countries
All authors
Gras, L.; Sighem, A. van; Bezemer, D.; Smit, C.; Wit, F.; Wolf, F. de; ATHENA Natl Observational Cohort S
Date
2011-03-27
Journal
AIDS
Volume
25
Issue
6
Pages
813 - 818
DOI
doi:10.1097/QAD.0b013e3283454cd7