Faculty Opinions recommendation of Effect of early versus deferred antiretroviral therapy for HIV on survival.
Notice bibliographique
Résumé
BACKGROUND: The optimal time for the initiation of antiretroviral therapy for asymptomatic patients with human immunodeficiency virus (HIV) infection is uncertain.METHODS: We conducted two parallel analyses involving a total of 17,517 asymptomatic patients with HIV infection in the United States and Canada who received medical care during the period from 1996 through 2005. None of the patients had undergone previous antiretroviral therapy. In each group, we stratified the patients according to the CD4+ count (351 to 500 cells per cubic millimeter or >500 cells per cubic millimeter) at the initiation of antiretroviral therapy. In each group, we compared the relative risk of death for patients who initiated therapy when the CD4+ count was above each of the two thresholds of interest (early-therapy group) with that of patients who deferred therapy until the CD4+ count fell below these thresholds (deferred-therapy group).RESULTS: In the first analysis, which involved 8362 patients, 2084 (25%) initiated therapy at a CD4+ count of 351 to 500 cells per cubic millimeter, and 6278 (75%) deferred therapy. After adjustment for calendar year, cohort of patients, and demographic and clinical characteristics, among patients in the deferred-therapy group there was an increase in the risk of death of 69%, as compared with that in the early-therapy group (relative risk in the deferred-therapy group, 1.69; 95% confidence interval [CI], 1.26 to 2.26; P< 0.001). In the second analysis involving 9155 patients, 2220 (24%) initiated therapy at a CD4+ count of more than 500 cells per cubic millimeter and 6935 (76%) deferred therapy. Among patients in the deferred-therapy group, there was an increase in the risk of death of 94% (relative risk, 1.94; 95% CI, 1.37 to 2.79; P< 0.001).CONCLUSIONS: The early initiation of antiretroviral therapy before the CD4+ count fell below two prespecified thresholds significantly improved survival, as compared with deferred therapy.2009 Massachusetts Medical Society PMID: 19339714 Funding information This work was supported by: NIA NIH HHS, United States Grant ID: R01 AG026250-01A2 NIAID NIH HHS, United States Grant ID: U01 AI042590 NIAID NIH HHS, United States Grant ID: P30 AI050410 NIAID NIH HHS, United States Grant ID: U01 AI068634 NIAID NIH HHS, United States Grant ID: U01 AI035040-07 NIDA NIH HHS, United States Grant ID: R01 DA011602-02 NIAID NIH HHS, United States Grant ID: U01 AI034989-16 NIAID NIH HHS, United States Grant ID: U01 AI042590-07 NIAID NIH HHS, United States Grant ID: U01 AI035039 NIAID NIH HHS, United States Grant ID: U01 AI038858-07 NIAID NIH HHS, United States Grant ID: U01 AI069918-04S1 NIAID NIH HHS, United States Grant ID: R24 AI067039-01A1 NIAID NIH HHS, United States Grant ID: U01 AI034993 NIAID NIH HHS, United States Grant ID: U01 AI035040 NIDA NIH HHS, United States Grant ID: R01 DA012568-01 NIAID NIH HHS, United States Grant ID: U01 AI034993-06 NIDA NIH HHS, United States Grant ID: K24 DA000432-09 NIAID NIH HHS, United States Grant ID: P30 AI054999-07 NIAID NIH HHS, United States Grant ID: K23 AI060464 NIDA NIH HHS, United States Grant ID: R01 DA012568 Intramural NIH HHS, United States Grant ID: Z01 CP010176-07 NIAID NIH HHS, United States Grant ID: P30 AI027757 NIAID NIH HHS, United States Grant ID: U01 AI035043 NIMH NIH HHS, United States Grant ID: R01 MH054907-15 NIAAA NIH HHS, United States Grant ID: U01 AA013566 NIAAA NIH HHS, United States Grant ID: R01 AA016893-01A2 NIAID NIH HHS, United States Grant ID: U01 AI069918 NIA NIH HHS, United States Grant ID: R01 AG026250 NIAAA NIH HHS, United States Grant ID: R21 AA015032 NICHD NIH HHS, United States Grant ID: U01 HD032632-16 NIAID NIH HHS, United States Grant ID: U01 AI042590-12 NCRR NIH HHS, United States Grant ID: M01 RR000052 NIAID NIH HHS, United States Grant ID: U01 AI034994 NIAID NIH HHS, United States Grant ID: U01 AI068636 NIAID NIH HHS, United States Grant ID: K01 AI071725-01A1 NIAID NIH HHS, United States Grant ID: U01 AI038858 NIAID NIH HHS, United States Grant ID: U01 AI038855-04 NIAID NIH HHS, United States Grant ID: U01 AI069918-01 NIAID NIH HHS, United States Grant ID: K01 AI071754 NIAID NIH HHS, United States Grant ID: U01 AI069432 NCRR NIH HHS, United States Grant ID: UL1 RR025747-02 NCRR NIH HHS, United States Grant ID: UL1 RR024131-047355 NIDA NIH HHS, United States Grant ID: K24 DA000432-10 NIAID NIH HHS, United States Grant ID: R24 AI067039 NIAID NIH HHS, United States Grant ID: U01 AI035041 NIAID NIH HHS, United States Grant ID: U01 AI035042-07 NIAID NIH HHS, United States Grant ID: U01 AI035039-07 NIAID NIH HHS, United States Grant ID: U01 AI035004-08S1 NIDA NIH HHS, United States Grant ID: R01 DA011602-11A2 NIAAA NIH HHS, United States Grant ID: R21 AA015032-02 NIAID NIH HHS, United States Grant ID: U01 AI034989 NCRR NIH HHS, United States Grant ID: UL1 RR024131 NIAID NIH HHS, United States Grant ID: U01 AI031834-07 NIDA NIH HHS, United States Grant ID: R01 DA004334 NIAID NIH HHS, United States Grant ID: U01 AI068634-01 NIAID NIH HHS, United States Grant ID: U01 AI038855 NIAID NIH HHS, United States Grant ID: U01 AI035041-07 NIAID NIH HHS, United States Grant ID: U01 AI069434-01 NIAID NIH HHS, United States Grant ID: P30 AI027757-229020 NIAID NIH HHS, United States Grant ID: U01 AI034994-06 NIDA NIH HHS, United States Grant ID: K24 DA000432 NIDA NIH HHS, United States Grant ID: R01 DA004334-21A2 NIAID NIH HHS, United States Grant ID: P30 AI054999 NIAID NIH HHS, United States Grant ID: P30 AI027767-17 NIAID NIH HHS, United States Grant ID: U01 AI035004 NCRR NIH HHS, United States Grant ID: M01 RR000052-46 NIAID NIH HHS, United States Grant ID: U01 AI069432-01 NIAAA NIH HHS, United States Grant ID: U01 AA013566-02 NIAID NIH HHS, United States Grant ID: U01 AI031834 NIDA NIH HHS, United States Grant ID: R56 DA004334 NIMH NIH HHS, United States Grant ID: R01 MH054907 NIAID NIH HHS, United States Grant ID: U01 AI035043-12 NIAID NIH HHS, United States Grant ID: K01 AI071725 NIDA NIH HHS, United States Grant ID: R01 DA011602 NIAID NIH HHS, United States Grant ID: P30 AI050410-099002 NIAID NIH HHS, United States Grant ID: K23 AI060464-05 NIAID NIH HHS, United States Grant ID: K01 AI071754-01A1 NIAID NIH HHS, United States Grant ID: U01 AI069434 NIAID NIH HHS, United States Grant ID: U01 AI068636-01 NIAID NIH HHS, United States Grant ID: U01 AI035042 NIAID NIH HHS, United States Grant ID: P30 AI027767 NIAAA NIH HHS, United States Grant ID: R01 AA016893 More Less keyboard_arrow_down
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,007 | 0,048 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,002 | 0,002 |
| Bibliométrie | 0,003 | 0,003 |
| Études des sciences et des technologies | 0,002 | 0,001 |
| Communication savante | 0,004 | 0,002 |
| Science ouverte | 0,003 | 0,001 |
| Intégrité de la recherche | 0,010 | 0,004 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,312 | 0,156 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».