Pythia T. Nieuwkerk|Milly Haverkort|R. Vriesendorp|P. H. Jos Frissen|Frank de Wolf|Mirjam A. G. Sprangers
Quality of Life After Starting Highly Active Antiretroviral Therapy for Chronic HIV-1 Infection at Different CD4 Cell Counts
Stichting HIV Monitoring|Academic Medical Center|Medisch Centrum Haaglanden|University of Amsterdam|Medisch Centrum Alkmaar|OLVG|Stichting HIV Monitoring|Academic Medical Center|Medisch Centrum Haaglanden|University of Amsterdam|Medisch Centrum Alkmaar|OLVG|Stichting HIV Monitoring|Academic Medical Center|Medisch Centrum Haaglanden|University of Amsterdam|Medisch Centrum Alkmaar|OLVG|Stichting HIV Monitoring|Academic Medical Center|Medisch Centrum Haaglanden|University of Amsterdam|Medisch Centrum Alkmaar|OLVG|Stichting HIV Monitoring|Academic Medical Center|Medisch Centrum Haaglanden|University of Amsterdam|Medisch Centrum Alkmaar|OLVG|Stichting HIV Monitoring|Academic Medical Center|Medisch Centrum Haaglanden|University of Amsterdam|Medisch Centrum Alkmaar|OLVG
editor optimal timing highly active antiretroviral therapy haart initiation chronic hiv1 infection issue ongoing debate observational studies shown increased risk mortality haart initiated patients cd4 cell counts less 200l compared initiation higher levels12 cd4 cell count greater 200l therapy initiated remains unclear however evidence inconsistent14 arguments favor initiating haart earlier course hiv infection comprise preservation immune function earlier control viral replication prolongation diseasefree survival previous years increased recognition longterm adverse effects haart difficulties adherence therapy outweighed arguments favor extremely early treatment timing haart initiation may also influence patients quality life qol previous studies shown positive effect haart patients qol delay disease progression5 time haart negative effect patients qol toxicities inconveniences associated regimens6 extent potential negative effects haart qol outweighed positive effects may depend timing haart initiation objective investigate patients qol starting haart different cd4 cell counts may 1998 december 2000 consecutive adult hiv1infected patients 22 hospitals netherlands starting already receiving haart enrolled observational cohort study called athena project7 subset entire athena population athena 600 group questionnaires qol administered patients sufficient literacy complete dutch english selfreport questionnaires questionnaires completed inclusion athena project every 6 months thereafter december 2000 receiving additional funding data collection qol restarted april 2002 november 2003 ended june 2005 present report selected patients commenced haart enrollment athena project completed qol questionnaire start haart least 1 questionnaire thereafter study approved institutional review boards participating centers patients gave written informed consent qol assessed medical outcomes study health survey hiv moshiv widely used 35item questionnaire qol hivaids established reliability validity8 responses items moshiv aggregated physical mental health summary scores summary scores transformed standard score mean 50 sd 10 higher scores indicating better qol9 patients categorized starting haart 200 cd4 cellsl 201 350 cd4 cellsl 350 cd4 cellsl investigated whether different pattern change time physical mental health among 3 groups using mixed linear models specifically growth curve models random intercepts slopes p values 005 considered indicate statistical significance data analysis conducted using spss software package windows version 12 spss chicago il total 265 566 patients enrolled athena 600 group december 2000 started haart enrollment athena project total 239 90 265 patients completed qol questionnaire start haart least 1 questionnaire thereafter 239 patients completed total 1439 questionnaires average 6 per patient number patients starting haart 200 cd4 cellsl 201 350 cd4 cellsl 350 cd4 cellsl 106 65 68 respectively median interquartile range iqr cd4 count start haart 3 groups 70 20 140 271 230 320 450 390 635 cellsl respectively median iqr plasma hiv rna load start haart 3 groups 52 48 55 50 45 53 48 44 50 log10 copiesml respectively percentage male subjects 3 groups 96 88 93 respectively mean sd age 3 groups 394 77 403 102 404 84 years respectively median iqr duration followup qol study 3 groups 42 21 53 44 19 54 48 40 56 years respectively patients started haart 200 cd4 cellsl significantly worse baseline physical health patients started haart 201 350 cellsl 350 cd4 cellsl fig 1a found statistically significant different pattern change time physical health among 3 groups patients started haart 200 cd4 cellsl significantly improvement physical health patients started haart 201 350 cd4 cellsl 350 cd4 cellsl p 0001 group time interaction 200 vs 201 350 cd4 cellsl p 0002 group time interaction 200 vs 350 cd4 cellsl found difference change time physical health patients started haart 201 350 cd4 cellsl versus 350 cd4 cellsl p 085 group time interaction 201 350 vs 350 cd4 cellsl different pattern change mental health among 3 groups mental health significantly improving time p 0013 time effect irrespective cd4 cell count start haart see fig 1b adjustment baseline plasma hiv rna concentration age gender calendar year haart initiation significantly affect comparison qol among 3 groups data shownfigure 1 physical mental health starting highly active antiretroviral therapy different cd4 cell counts black line indicates 200 cd4 cellsl start haart gray line indicates 201 350 cd4 cellsl start haart black dotted line indicates 350 cd4 cellsl start haartin conclusion qol improved among patients started haart 200 cd4 cellsl among 200 cd4 cellsl found difference impact haart qol patients started haart 201 350 cd4 cellsl versus started haart 350 cd4 cellsl although qol taken account deciding haart initiation individual patient10 likely decisive factor group level among patients 200 cd4 cellsl acknowledgments authors thank participants study study supported grant 6003 aids fund amsterdam netherlands pythia nieuwkerk phd milly e hillebrandhaverkort md phd robert vriesendorp md phd p h jos frissen md phd frank de wolf md phd mirjam g sprangers phd athena study group academic medical center university amsterdam amsterdam netherlands medisch centrum alkmaar alkmaar netherlands medisch centrum haaglanden den haag netherlands onze lieve vrouwe gasthuis amsterdam netherlands hiv monitoring foundation amsterdam netherlands