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首页> 外文期刊>JAIDS: Journal of acquired immune deficiency syndromes >HIV antiretroviral treatment: early versus later.
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HIV antiretroviral treatment: early versus later.

机译：HIV抗逆转录病毒治疗：早晚。

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OBJECTIVES: Cohort studies indicate that starting highly active antiretroviral therapy (HAART) when the CD4+ T-cell count is less than 200 cells/muL is associated with poor outcomes. These studies have been unable to address how early HAART should be initiated, however. This report uses a modeling approach to compare starting HAART at a mean CD4+ T-cell count greater than 350 cells/microL (early) versus less than 350 cells/microL but greater than 200 cells/microL (later). METHODS: A Markov model tracks people with HIV infection through 6 disease stages defined by CD4+ T-cell count ranges over a 25-year period. Transition probabilities between the disease stages for 6-month periods vary according to initial viral load. Sequences of different first-line, second-line, and "salvage" antiretroviral regimens are defined, and their impact on transition probabilities is estimated. HAART effectiveness is based on data from an urban hospital-based HIV clinic, supplemented by clinical trial data. The model computes the incremental cost-effectiveness of alternative treatment patterns and includes sensitivity analyses for a range of plausible alternative input values. RESULTS: Starting HAART earlier rather than later increases total lifetime costs by Dollars 19,074, increases years of life by 1.21 years, increases discounted quality-adjusted life-years by 0.61, and has an incremental cost-effectiveness ratio of Dollars 31,266 per quality-adjusted life-year. Early therapy is more cost-effective when the impact of HAART on well-being is smaller. CONCLUSIONS: Initiation of HAART at a CD4+ T-cell count greater than 350 cells/microL may be cost-effective (less than Dollars 50,000 per quality-adjusted life-year) compared with initiating HAART at a CD4+ T-cell count less than 350 cells/microL but greater than 200 cells/muL and may result in longer quality-adjusted survival.
机译：目的：队列研究表明，当CD4 + T细胞计数低于200细胞/μL时开始高活性抗逆转录病毒疗法（HAART）与不良预后相关。但是，这些研究无法解决应如何早期启动HAART。该报告使用一种建模方法来比较起始HAART的平均CD4 + T细胞计数大于350个细胞/微升（早期）与小于350个细胞/微升但大于200个细胞/微升（以后）。方法：一个马尔可夫模型追踪在25年内CD4 + T细胞计数范围所定义的6个疾病阶段的HIV感染者。根据初始病毒载量，疾病阶段之间6个月过渡的可能性不同。定义了不同的一线，二线和“挽救”抗逆转录病毒治疗方案的序列，并估计了它们对过渡机率的影响。 HAART的有效性基于城市医院的HIV诊所的数据，并附有临床试验数据。该模型计算替代治疗模式的增量成本效益，并包括对一系列可能的替代输入值的敏感性分析。结果：更早而非更早地启动HAART，将使总生命周期成本增加19,074美元，使寿命增加1.21年，对质量调整后的折现年限增加0.61，并且每次质量调整后的成本效益比增加31,266美元生命年。当HAART对健康的影响较小时，早期治疗更具成本效益。结论：与在小于或等于350个CD4 + T细胞计数的情况下启动HAART相比，在大于或等于350个细胞/ microL的CD4 + T细胞计数下进行HAART治疗可能具有成本效益（每质量调整生命年少于50,000美元）。细胞/微升，但大于200细胞/微升，可能会导致更长的质量调整后的生存期。

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