Browsing by Author "Murillas, Javier"

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    Determinants of HIV Progression and Assessment of the Optimal Time to Initiate Highly Active Antiretroviral Therapy
    (2008-02-01) Jaén, Ángeles; Esteve, Anna; Miró, Josep M; Tural, Cristina; Montoliu, Alexandra; Ferrer, Elena; Riera, Melcior; Segura, Ferran; Force, Lluis; Sued, Omar; Vilaró, Josep; Garcia, Isabel; Masabeu, Angels; Altès, Jordi; Clotet, Bonaventura; Podzamczer, Daniel; Murillas, Javier; Navarro, Gemma; Gatell, Jose; Casabona, Jordi; the PISCIS Study Group
    Objective: We analyze the factors related to progression to AIDS or death in HIV-infected patients from the Proyecto para la Informatización del Seguimiento Clínico epidemiológico de los pacientes con Infección por VIH/SIDA (PISCIS) Cohort and we assess the optimal time to initiate highly active antiretroviral therapy (HAART) taking lead time into account. Methods: We selected naive patients who were AIDS-free and initiated HAART after January 1998. Statistical analyses were performed using Cox proportional hazards models. Lead time was defined as the time it took the deferred group with an early disease stage to reach the later stage. The analysis accounting for lead time was performed using multiple imputation methods based on estimates from the pre-HAART period as described elsewhere. Results: Multivariate analysis on 2035 patients (median follow-up = 34.3 months) showed significantly higher hazard ratios (HRs) for a CD4 count <200 cells/μL (HR = 3.79, 95% confidence interval [CI]: 2.18 to 6.57), HIV-1 RNA level >100,000 copies/mL (HR = 1.84, 95% CI: 1.26 to 2.69), and hepatitis C virus (HCV) coinfection (HR = 2.40, 95% CI: 1.65 to 3.49), whereas a lower risk was found for those who started HAART between January 2001 and June 2004 (HR = 0.55, 95% CI: 0.30 to 0.90). When lead time and unseen events were included, we found a higher risk of progression to AIDS among patients who deferred treatment when the CD4 count reached <200 cells/μL (HR = 2.97, 95% CI: 1.91 to 4.63) and 200 to 350 cells/μL (HR = 1.85, 95% CI: 1.03 to 3.33) compared with those who started treatment with CD4 counts from 200 to 350 cells/μL and >350 cells/μL, respectively. Conclusions: Advanced HIV disease, HCV coinfection, and early HAART period were determinants of AIDS progression or death. Lead-time analysis in asymptomatic HIV-infected patients suggests that the best time to start HAART is before the CD4 count falls to lower than 350 cells/μL.
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    HIV-1 infected patients older than 50 years. PISCIS cohort study
    (2008) Navarro, Gemma; Nogueras, Maria M.; Segura, Ferran; Casabona, Jordi; Miro, Jose M.; Murillas, Javier; Tural, Cecilio; Ferrer, Enrique; Jaén, Amelia; Force, Laura; Vilaró, Laura; García, Iván; Masabeu, Antoni; Altés, José; Esteve, Albert; Sued, Omar; Riera, Maria; Clotet, Bonaventura; Podzamczer, Daniel; Gatell, Jose; PISCIS Study Group
    Objective: The aim of this study is to characterize the ways in which older HIV-infected people differ from younger HIV-infected people. Methods: Prospective cohort study. PISCIS cohort includes newly attended HIV-infected subjects since January 1, 1998. Naive patients were selected. Two groups were defined: G1 (>or=50 years at time of diagnosis, n=493) and G2 (18-49 years, n=4511). Statistical analysis was performed using chi(2), Student's t test, Cox regression and linear mixed models. Results: G1 had different features: males (G1: 84% vs. G2: 75%, p<0.001), sexual transmission (52% vs. 32%, p<0.001), AIDS at first visit (38% vs. 22%, p<0.001). The follow-up was 6 years. Ninety-five percent of patients in G1 and 92% in G2 presented a detectable viral load (>or=500 copies/mm(3)) at the first visit (p=0.016). G1 presented lower CD4 levels with respect to G2 throughout the period but the increase of CD4 in G1 at the end of the study period was 254 cells/mm(3) whereas for G2 it was 196 cells/mm(3) (p<0.001). Mortality was 9% for G1 and 4% for G2 (p<0.001). Conclusions: HIV-infected people diagnosed at the age of 50 years or older showed different features. They showed good viral and immunological response to HAART.