From CD4-Based Initiation to Treating All HIV-Infected Adults Immediately: An Evidence-Based Meta-analysis

Frontiers in Immunology
Aixin SongHao Wu

Abstract

The World Health Organization (WHO) Consolidated antiretroviral therapy (ART) guidelines set the CD4+ T-cell counts threshold to 500 cells/mm3 in 2013, and 2015 guidelines recommend treating all HIV-infected adults regardless of their CD4+ T-cell counts. To inform the decision-making around ART guidelines for people living with HIV, we systematically reviewed the literature to estimate differences in clinical benefits between individuals starting treatment with baseline CD4+ T-cell counts ≥500 cells/mm3 (early initiation) as compared to <500 cells/mm3 (deferred initiation). We systematically searched the electronic databases and abstracts for randomized controlled trials (RCT) and observational studies. Outcomes were mortality, AIDS progression, AIDS or death, immunologic recovery, and virologic suppression. We pooled data across studies and performed analyses of effect sizes. We identified 13 studies comparing early and deferred treatment. The pooled risk ratio (RR) of mortality of 11 observational studies was 0.90 (95% CI 0.82-0.99), with moderate heterogeneity (I2 = 53%). The pooled RR for progression to AIDS from two observational studies was 0.77 (95% CI 0.47-1.24). Five observational studies found a pooled RR of death or ...Continue Reading

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Citations

Mar 6, 2019·Journal of the International Association of Providers of AIDS Care·Yan ZhaoZunyou Wu
Jun 10, 2020·The Pediatric Infectious Disease Journal·Yohannes EjiguMaria Christine Magnus
Jan 23, 2019·BMC Infectious Diseases·Agnes N KiraggaBarbara Castelnuovo
Feb 12, 2021·Frontiers in Immunology·Christine MölzerJohn V Forrester

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