Quand débuter les antirétroviraux? Recommandations

Quand débuter les antirétroviraux?
Recommandations internationales
Formation à l’usage des
antirétroviraux
Pr Willy Rozenbaum

clinicaloptions.com/hiv
When to Start Antiretroviral Therapy
Potential Benefits of Early Therapy
Earlier suppression of viral replication
Preservation of immune function
Prolongation of disease-free survival
Lower risk of virologic failure?
Lower risk of detrimental viral evolution
Possible decrease in the risk of HIV transmission

clinicaloptions.com/hiv
When to Start Antiretroviral Therapy
CD4+ Cell Count Response Based on
Baseline CD4+ Cell Count
Keruly J, et at. CROI 2006. Abstract 529.
Gras L, et al. CROI 2006. Abstract 530.
048 96 144 192 240 288 336
Years on HAART
ATHENA National Cohort
Johns Hopkins HIV Clinical Cohort
Mean CD4+ Cell Count
(cells/mm3)
200
400
600
800
0
01 2 3 4 5
Weeks From Starting HAART
1000
200
400
600
800
0
1000
> 500
351-500
201-350
51-200
< 50
BL CD4
> 350
< 200
201-350
BL CD4

clinicaloptions.com/hiv
When to Start Antiretroviral Therapy
101-200 cells/mm3
201-350 cells/mm3
351-500 cells/mm3
HAART and Survival Based on Initial
CD4+ Cell Count
Modeled data from ART Cohort
Collaborative
10,855 patients included
934 progressed to AIDS or died
IDUs censored from model
D’Arminio Monforte A, et al. CROI 2006. Abstract 525.
Cumulative Probability of AIDS/Death According
to CD4+ Cell Count at Initiation of HAART
Years Since Initiation of HAART
01 2 34 5
0.00
0.02
0.04
0.06
0.08
0.10
0.12
Probability of AIDS or Death
0.14
Progression and Death According
to CD4+ Cell Count (cells/mm3)
< 200 vs
201-350 < 350 vs 351-500
Hazard ratio for
AIDS (95% CI) 3.68 (3.01-4.51) 1.52 (1.10-2.10)
Hazard ratio for
AIDS or death
(95% CI)
2.93
(2.41-3.57) 1.26 (0.94-1.68)