| HIV antiretroviral treatment: early versus later. | |
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MedLine Citation:
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PMID: 16044008 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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 $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 $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 $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. |
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Authors:
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Josephine Mauskopf; Mari Kitahata; Teresa Kauf; Anke Richter; Jerry Tolson |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Journal of acquired immune deficiency syndromes (1999) Volume: 39 ISSN: 1525-4135 ISO Abbreviation: J. Acquir. Immune Defic. Syndr. Publication Date: 2005 Aug |
Date Detail:
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Created Date: 2005-07-26 Completed Date: 2005-09-14 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 100892005 Medline TA: J Acquir Immune Defic Syndr Country: United States |
Other Details:
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Languages: eng Pagination: 562-9 Citation Subset: IM; X |
Affiliation:
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RTI Health Solutions, Research Triangle Park, NC 27709, USA. jmauskopf@rti.org |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Antiretroviral Therapy, Highly Active
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economics*,
methods* CD4 Lymphocyte Count Cost-Benefit Analysis Drug Administration Schedule HIV Infections / drug therapy* Humans Longevity Markov Chains Models, Statistical Quality of Life Viral Load |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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