Faculty Opinions recommendation of Effect of early versus deferred antiretroviral therapy for HIV on survival.
Bibliographic record
Abstract
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
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.007 | 0.048 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.003 | 0.003 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.003 | 0.001 |
| Research integrity | 0.010 | 0.004 |
| Insufficient payload (model declined to judge) | 0.312 | 0.156 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".