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Optimal time for initiation of antiretroviral therapy in asymptomatic, HIV-infected, treatment-naive adults

  1. Nandi Siegfried1,*,
  2. Olalekan A Uthman2,
  3. George W Rutherford3

Editorial Group: Cochrane HIV/AIDS Group

Published Online: 17 MAR 2010

Assessed as up-to-date: 12 NOV 2009

DOI: 10.1002/14651858.CD008272.pub2


How to Cite

Siegfried N, Uthman OA, Rutherford GW. Optimal time for initiation of antiretroviral therapy in asymptomatic, HIV-infected, treatment-naive adults. Cochrane Database of Systematic Reviews 2010, Issue 3. Art. No.: CD008272. DOI: 10.1002/14651858.CD008272.pub2.

Author Information

  1. 1

    University of Cape Town, Department of Public Health and Primary Health Care, Cape Town, South Africa

  2. 2

    University of Birmingham, WMHTAC, Public Health, Epidemiology & Biostatistics, Birmingham, UK

  3. 3

    University of California, San Francisco, Global Health Sciences, San Francisco, California, USA

*Nandi Siegfried, Department of Public Health and Primary Health Care, University of Cape Town, Cape Town, South Africa. nandi.siegfried@gmail.com.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 17 MAR 2010

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References

References to studies included in this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to ongoing studies
  4. Additional references
CIPRAHT001 2009 {unpublished data only}
  • Fitzgerald D. A randomized clinical trial of early versus strandard antiretroviral therapy for HIV-infected patients with a CD4 T cell count of 200 - 350 cells/ml (CIPRA HT 001). International AIDS Society Conference, Cape Town 2009.
SMART 2008 {published data only}
  • El-Sadr WM, Lundgren JD, Neaton JD, Gordin F, Abrams D, Arduino RC, et al. CD4+ count-guided interruption of antiretroviral treatment. The New England journal of medicine 2006;355(22):2283-96. [PUBMED: 17135583]
  • Lundgren JD, Babiker A, El-Sadr W, Emery S, Grund B, Neaton JD, et al. 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. The Journal of infectious diseases 2008;197(8):1145-55. [PUBMED: 18476293]
  • The Strategies for Management of Antiretroviral Therapy (SMART) Study Group. Major clinical outcomes in antiretroviral therapy (ART)-naive participants and in those not receiving ART at baseline in the SMART study. The Journal of Infectious Diseases 2008;197(15 April):1133-44.

References to studies excluded from this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to ongoing studies
  4. Additional references
Erhabor 2006 {published data only}
  • Erhabor O, Ejele OA, Uko EK. HAART – Dependent CD4+ Lymphocyte Response Based onPre-Therapeutic CD4 Lymphocyte Count in HIV-Infected Nigerians. Annals of African Medicine 2006;5(3):153-7.

References to ongoing studies

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to ongoing studies
  4. Additional references
NCT00491556 {published data only}
  • Early initiation of HAART. Ongoing study October 2007.
START 2009 {published data only}
  • Strategic Timing of Antiretroviral Treatment (START). Ongoing study March 2009.

Additional references

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to ongoing studies
  4. Additional references
Badri 2004
  • Badri M, Bekker LG, Orrell C, Pitt J, Cilliers F, Wood R. Initiating highly active antiretroviral therapy in sub-Saharan Africa: an assessment of the revised World Health Organization scaling-up guidelines. AIDS (London, England) 2004;18(8):1159-68. [PUBMED: 15166531]
Braithwaite 2008
  • Braithwaite RS, Roberts MS, Chang CC, Goetz MB, Gibert CL, Rodriguez-Barradas MC, et al. Influence of alternative thresholds for initiating HIV treatment on quality-adjusted life expectancy: a decision model. Annals of internal medicine 2008;148(3):178-85. [PUBMED: 18252681]
DAIDS 2009
  • Division of AIDS. Table for grading the severity of Adult and Pediatric Adverse Events. Accessed 28 October 2009 http://rcc.tech-res.com/Document/safetyandpharmacovigilance/DAIDS_AE_GradingTable_Clarification_August2009_Final.pdf.
Day 2002
  • Day J, Brink B, Charalambous S, Churchyard G, Grant A, Morris D, et al. Clinical and operational guidelines for use of antiretroviral therapy in adults. Aurum Health Research 2002.
Deeks 2006
Erhabor 2006
  • Erhabor O, Ejele OA, Uko EK. HAART - Dependent CD4+ Lymphocyte Response Based on Pre-Therapeutic CD4 Lymphocyte Count in HIV-Infected Nigerians. Annals of African Medicine 2006;5(3):153-57. [PUBMED: 17319344]
Granich 2009
  • Granich RM, Gilks CF, Dye C, De Cock KM, Williams BG. Universal voluntary HIV testing with immediate antiretroviral therapy as a strategy for elimination of HIV transmission: a mathematical model. Lancet 2009;373(9657):48-57.
Hammer 2008
  • Hammer SM, Eron JJ Jr, Reiss P, Schooley RT, Thompson MA, Walmsley S, Cahn P, Fischl MA, Gatell JM, Hirsch MS, Jacobsen DM, Montaner JS, Richman DD, Yeni PG, Volberding PA, International AIDS Society-USA. Antiretroviral treatment of adult HIV infection: 2008 recommendations of the International AIDS Society-USA panel. JAMA 2008;300(5):555-70.
Higgins 2002
Higgins 2008
  • Higgens JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.0 [updated February 2008]. The Cochrane Collaboration, 2008. [: Available from www.cochrane-handbook.org]
Kim 1987
Kitahata 2009
  • Kitahata MM, Gange SJ, Abraham AG, Merriman B, Saag MS, Justice AC, et al. Effect of Early versus Deferred Antiretroviral Therapy for HIV on Survival. The New England journal of medicine 2009. [PUBMED: 19339714]
Loubiere 2008
  • Loubiere S, el Filal KM, Sodqi M, Loundou A, Luchini S, Cleary S, et al. When to initiate highly active antiretroviral therapy in low-resource settings: the Moroccan experience. Antiviral therapy 2008;13(2):241-51. [PUBMED: 18505175]
Moh 2007
  • Moh R, Danel C, Messou E, Ouassa T, Gabillard D, Anzian A, et al. Incidence and determinants of mortality and morbidity following early antiretroviral therapy initiation in HIV-infected adults in West Africa. AIDS (London, England) 2007;21(18):2483-91. [PUBMED: 18025885]
Montori 2005
Orrell 2007
  • Orrell C, Harling G, Lawn SD, Kaplan R, McNally M, Bekker L, Wood R. Conservation of first-line antiretroviral treatmentregimen where therapeutic options are limited. Antiviral Therapy 2007;12.
Palella 2003
  • Palella FJ Jr, Deloria-Knoll M, Chmiel JS, Moorman AC, Wood KC, Greenberg AE, Holmberg SD, HIV Outpatient Study Investigators. Survival benefit of initiating antiretroviral therapy in HIV-infected persons in different CD4+ cell strata. Ann Intern Med 2003;138(8):620-6..
Sabin 2009
  • Sabin CA, Phillips AN. Should HIV therapy be started at a CD4 cell count above 350 cells/microl in asymptomatic HIV-1-infected patients?. Current opinion in infectious diseases 2009;22(2):191-7. [PUBMED: 19283914]
Schackman 2002
  • Schackman BR, Freedberg KA, Weinstein MC, Sax PE, Losina E, Zhang H, Goldie SJ. Cost-effectiveness implications of the timing of antiretroviral therapy in HIV-infected adults. Arch Intern Med 2002;162(21):2478-86.
Schrader 2008
  • Schrader S, Chuck SK, Rahn LW, Parekh P, Emrich KG. Significant improvements in self-reported gastrointestinal tolerability, quality of life, patient satisfaction, and adherence with lopinavir/ritonavir tablet formulation compared with soft gel capsules. AIDS research and therapy 2008;5:21. [PUBMED: 18799008]
Sterling 2001
  • Sterling TR, Chaisson RE, Moore RD. HIV-1 RNA, CD4 T-lymphocytes, and clinical response to highly active antiretroviral therapy. AIDS (London, England) 2001;15(17):2251-7. [PUBMED: 11698698]
Sterne 2009
  • Sterne JA, May M, Costagliola D, de Wolf F, Phillips AN, Harris R, et al. Timing of initiation of antiretroviral therapy in AIDS-free HIV-1-infected patients: a collaborative analysis of 18 HIV cohort studies. Lancet 2009;373(9672):1352-63. [PUBMED: 19361855]
Walensky 2009
  • Walensky RP, Wolf LL, Wood R, Fofana MO, Freedberg KA, Martinson NA, et al. When to start antiretroviral therapy in resource-limited settings. Annals of internal medicine 2009;151(3):157-66. [PUBMED: 19620143]
WHO 2006
  • Charles Gilks, Marco Vitorio and the World Health Organisation guidelines development group. Antiretroviral therapy for HIV infection in adults and adolescents: recommendations for a public health approach - 2006 revision. http://www.who.int/hiv/pub/guidelines/adult/en/index.html (accessed July 2007).
WHO 2009
  • World Health Organization. Rapid advice: Antiretroviral therapy for HIV infection in adults and adolescents. Geneva: World Health Organization November 2009.
Wong 2007
  • Wong KH, Chan KC, Cheng KL, Chan WK, Kam KM, Lee SS. Establishing CD4 thresholds for highly active antiretroviral therapy initiation in a cohort of HIV-infected adult Chinese in Hong Kong. AIDS patient care and STDs 2007;21(2):106-15. [PUBMED: 17328660]