Symptomatic Illness and Low CD4 Cell Count at HIV Seroconversion as Markers of Severe Primary HIV Infection
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{"title"=>"Symptomatic illness and low CD4 cell count at HIV seroconversion as markers of severe primary HIV infection", "type"=>"journal", "authors"=>[{"first_name"=>"Sara", "last_name"=>"Lodi", "scopus_author_id"=>"35248544600"}, {"first_name"=>"Martin", "last_name"=>"Fisher", "scopus_author_id"=>"55559682600"}, {"first_name"=>"Andrew", "last_name"=>"Phillips", "scopus_author_id"=>"35372648800"}, {"first_name"=>"Andrea", "last_name"=>"De Luca", "scopus_author_id"=>"7201948233"}, {"first_name"=>"Jade", "last_name"=>"Ghosn", "scopus_author_id"=>"57197587205"}, {"first_name"=>"Ruslan", "last_name"=>"Malyuta", "scopus_author_id"=>"11539661200"}, {"first_name"=>"Robert", "last_name"=>"Zangerle", "scopus_author_id"=>"7005799741"}, {"first_name"=>"Santiago", "last_name"=>"Moreno", "scopus_author_id"=>"7203036595"}, {"first_name"=>"Philippe", "last_name"=>"Vanhems", "scopus_author_id"=>"7005124320"}, {"first_name"=>"Faroudy", "last_name"=>"Boufassa", "scopus_author_id"=>"6701475038"}, {"first_name"=>"Marguerite", "last_name"=>"Guiguet", "scopus_author_id"=>"19434602300"}, {"first_name"=>"Kholoud", "last_name"=>"Porter", "scopus_author_id"=>"7202104963"}], "year"=>2013, "source"=>"PLoS ONE", "identifiers"=>{"issn"=>"19326203", "scopus"=>"2-s2.0-84893639218", "pmid"=>"24244330", "doi"=>"10.1371/journal.pone.0078642", "pui"=>"372334620", "isbn"=>"1932-6203 (Electronic)\\r1932-6203 (Linking)", "sgr"=>"84893639218"}, "id"=>"5c95d06b-b7bf-3084-a34c-00d266c7990f", "abstract"=>"BACKGROUND: The risk/benefit of initiating ART in primary HIV infection (PHI) is unclear. The benefits are more likely to outweigh the risks in patients with severe PHI. An accepted definition of severe PHI is, however, lacking.\\n\\nMETHODS: CASCADE patients with HIV test interval <6 months were classified as severe and non-severe PHI based on whether the following traits were recorded in the first 6 months following seroconversion: severe specific pre-defined symptoms, central nervous system-implicated illness, and ≥1, ≥2 CD4<350 (and <500) cells/mm(3). For each definition, we used Kaplan-Meier curves and Cox survival models to compare time to AIDS/death, censoring at the earlier of last clinic visit or 1/1/1997, when combination antiretroviral therapy (cART) became available.\\n\\nRESULTS: Among 1108 included patients mostly males (85%) infected through sex between men (71%), 366 were diagnosed with AIDS/died. The risk of AIDS/death was significantly higher for individuals with severe symptoms, those with ≥1 CD4<350 cells/mm(3) or ≥2 CD4 <500 cells/mm(3) in the first 6 months [aHR (95% confidence interval) 2.1 (1.4,3.2), 2.0 (1.5,2.7), and 2.3, (1.5-3.5) respectively]. Median [interquantile range] survival for patients with ≥2, ≥1 and no CD4<350 cells/mm(3) within 6 months of seroconversion was 3.9 [2.7,6.5], 5.4 [4.5,8.4] and 8.1 [4.3,10.3] years, respectively. The diagnosis of CNS-implicated symptoms was rare and did not appear to be prognostic.\\n\\nCONCLUSION: One CD4 count <350 or two <500 cells/mm(3) within 6 months of seroconversion and/or severe illness in PHI may be useful early indicators of individuals at high risk of disease progression.", "link"=>"http://www.mendeley.com/research/symptomatic-illness-low-cd4-cell-count-hiv-seroconversion-markers-severe-primary-hiv-infection", "reader_count"=>24, "reader_count_by_academic_status"=>{"Unspecified"=>1, "Professor > Associate Professor"=>3, "Researcher"=>4, "Student > Doctoral Student"=>1, "Student > Ph. D. Student"=>7, "Student > Master"=>3, "Other"=>2, "Student > Bachelor"=>2, "Professor"=>1}, "reader_count_by_user_role"=>{"Unspecified"=>1, "Professor > Associate Professor"=>3, "Researcher"=>4, "Student > Doctoral Student"=>1, "Student > Ph. D. Student"=>7, "Student > Master"=>3, "Other"=>2, "Student > Bachelor"=>2, "Professor"=>1}, "reader_count_by_subject_area"=>{"Unspecified"=>2, "Biochemistry, Genetics and Molecular Biology"=>2, "Mathematics"=>2, "Agricultural and Biological Sciences"=>4, "Medicine and Dentistry"=>12, "Chemistry"=>1, "Social Sciences"=>1}, "reader_count_by_subdiscipline"=>{"Medicine and Dentistry"=>{"Medicine and Dentistry"=>12}, "Chemistry"=>{"Chemistry"=>1}, "Social Sciences"=>{"Social Sciences"=>1}, "Agricultural and Biological Sciences"=>{"Agricultural and Biological Sciences"=>4}, "Biochemistry, Genetics and Molecular Biology"=>{"Biochemistry, Genetics and Molecular Biology"=>2}, "Mathematics"=>{"Mathematics"=>2}, "Unspecified"=>{"Unspecified"=>2}}, "reader_count_by_country"=>{"Argentina"=>1}, "group_count"=>1}

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Figshare

  • {"files"=>["https://ndownloader.figshare.com/files/1281946"], "description"=>"<p>The dashed line shows a relative risk of 1 for a CD4 count of 500 cells/mm<sup>3</sup>. Risk adjusted for sex, exposure category and age at HIV seroconversion.</p>", "links"=>[], "tags"=>["aids", "hiv", "seroconversion", "lowest", "cd4", "recorded", "months"], "article_id"=>851573, "categories"=>["Biological Sciences"], "users"=>["Sara Lodi", "Martin Fisher", "Andrew Phillips", "Andrea De Luca", "Jade Ghosn", "Ruslan Malyuta", "Robert Zangerle", "Santiago Moreno", "Philippe Vanhems", "Faroudy Boufassa", "Marguerite Guiguet", "Kholoud Porter"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0078642.g001", "stats"=>{"downloads"=>0, "page_views"=>6, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Risk_of_AIDS_and_or_death_after_HIV_seroconversion_by_lowest_CD4_count_recorded_in_the_first_6_months_of_HIV_diagnosis_/851573", "title"=>"Risk of AIDS and/or death after HIV seroconversion by lowest CD4 count recorded in the first 6 months of HIV diagnosis.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2013-11-14 04:36:51"}
  • {"files"=>["https://ndownloader.figshare.com/files/1281947"], "description"=>"<p>Abbreviations: SC = seroconversion, IQR = Interquantile range.</p>", "links"=>[], "tags"=>["included", "patients", "separately", "immunological", "definitions", "hiv"], "article_id"=>851574, "categories"=>["Biological Sciences"], "users"=>["Sara Lodi", "Martin Fisher", "Andrew Phillips", "Andrea De Luca", "Jade Ghosn", "Ruslan Malyuta", "Robert Zangerle", "Santiago Moreno", "Philippe Vanhems", "Faroudy Boufassa", "Marguerite Guiguet", "Kholoud Porter"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0078642.t001", "stats"=>{"downloads"=>0, "page_views"=>7, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Characteristics_of_included_patients_overall_and_separately_for_clinical_and_immunological_definitions_of_severe_primary_HIV_infection_PHI_/851574", "title"=>"Characteristics of included patients overall and separately for clinical and immunological definitions of severe primary HIV infection (PHI).", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2013-11-14 04:36:51"}
  • {"files"=>["https://ndownloader.figshare.com/files/1281953"], "description"=>"a<p>- bronchitis, pneumonia, oral candidiasis, thrombocytopenia, viral meningitis, bacterial meningitis, encephalitis, neuropathy, Candida pharyngitis.</p>b<p>- viral meningitis, bacterial meningitis, encephalitis, neuropathy.</p>*<p>Adjusted for sex, risk group (sex between men, injecting drug use, sex between men and women, other/unknown), age at HIV seroconversion (≤30 and >30 years) and first CD4 count (<350, 351–500 and >500 cells/mm<sup>3</sup>).</p>¤<p>Adjusted for sex, risk group (sex between men, injecting drug use, sex between men and women, other/unknown), age at HIV seroconversion (≤30 and >30 years).</p>¥<p>Long rank test for difference in survivor probabilities.</p>§<p>Cox semiparametric survival model.</p>†<p>Heterogeneity test for categorical variables.</p>‡<p>The symbol “-” for median survival time indicates that fewer than 50% of patients at risk have experienced the event by the end of follow-up.</p>◊<p>Analyses only included patients with at least 2 CD4 counts measured in the first 6 months of HIV diagnosis.</p>", "links"=>[], "tags"=>["aids", "hiv"], "article_id"=>851577, "categories"=>["Biological Sciences"], "users"=>["Sara Lodi", "Martin Fisher", "Andrew Phillips", "Andrea De Luca", "Jade Ghosn", "Ruslan Malyuta", "Robert Zangerle", "Santiago Moreno", "Philippe Vanhems", "Faroudy Boufassa", "Marguerite Guiguet", "Kholoud Porter"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0078642.t002", "stats"=>{"downloads"=>0, "page_views"=>4, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Risk_of_AIDS_and_or_death_according_to_definition_of_severe_primary_HIV_infection_PHI_/851577", "title"=>"Risk of AIDS and/or death according to definition of severe primary HIV infection (PHI).", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2013-11-14 04:36:51"}
  • {"files"=>["https://ndownloader.figshare.com/files/1281954"], "description"=>"<div><p>Background</p><p>The risk/benefit of initiating ART in primary HIV infection (PHI) is unclear. The benefits are more likely to outweigh the risks in patients with severe PHI. An accepted definition of severe PHI is, however, lacking.</p><p>Methods</p><p>CASCADE patients with HIV test interval <6 months were classified as severe and non-severe PHI based on whether the following traits were recorded in the first 6 months following seroconversion: severe specific pre-defined symptoms, central nervous system-implicated illness, and ≥1, ≥2 CD4<350 (and <500) cells/mm<sup>3</sup>. For each definition, we used Kaplan-Meier curves and Cox survival models to compare time to AIDS/death, censoring at the earlier of last clinic visit or 1/1/1997, when combination antiretroviral therapy (cART) became available.</p><p>Results</p><p>Among 1108 included patients mostly males (85%) infected through sex between men (71%), 366 were diagnosed with AIDS/died. The risk of AIDS/death was significantly higher for individuals with severe symptoms, those with ≥1 CD4<350 cells/mm<sup>3</sup> or ≥2 CD4 <500 cells/mm<sup>3</sup> in the first 6 months [aHR (95% confidence interval) 2.1 (1.4,3.2), 2.0 (1.5,2.7), and 2.3, (1.5–3.5) respectively]. Median [interquantile range] survival for patients with ≥2, ≥1 and no CD4<350 cells/mm<sup>3</sup> within 6 months of seroconversion was 3.9 [2.7,6.5], 5.4 [4.5,8.4] and 8.1 [4.3,10.3] years, respectively. The diagnosis of CNS-implicated symptoms was rare and did not appear to be prognostic.</p><p>Conclusion</p><p>One CD4 count <350 or two <500 cells/mm<sup>3</sup> within 6 months of seroconversion and/or severe illness in PHI may be useful early indicators of individuals at high risk of disease progression.</p></div>", "links"=>[], "tags"=>["cd4", "hiv", "seroconversion", "markers"], "article_id"=>851578, "categories"=>["Biological Sciences"], "users"=>["Sara Lodi", "Martin Fisher", "Andrew Phillips", "Andrea De Luca", "Jade Ghosn", "Ruslan Malyuta", "Robert Zangerle", "Santiago Moreno", "Philippe Vanhems", "Faroudy Boufassa", "Marguerite Guiguet", "Kholoud Porter"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0078642", "stats"=>{"downloads"=>2, "page_views"=>8, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Symptomatic_Illness_and_Low_CD4_Cell_Count_at_HIV_Seroconversion_as_Markers_of_Severe_Primary_HIV_Infection_/851578", "title"=>"Symptomatic Illness and Low CD4 Cell Count at HIV Seroconversion as Markers of Severe Primary HIV Infection", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2013-11-14 04:36:51"}
  • {"files"=>["https://ndownloader.figshare.com/files/1281949"], "description"=>"a<p>- bronchitis, pneumonia, oral candidiasis, thrombocytopenia, viral meningitis, bacterial meningitis, encephalitis, neuropathy, Candida pharyngitis.</p>b<p>- viral meningitis, bacterial meningitis, encephalitis, neuropathy.</p>*<p>Adjusted for sex, risk group (sex between men, injecting drug use, sex between men and women, other/unknown), age at HIV seroconversion (≤30 and >30 years) and first CD4 count (<350, 351–500 and >500 cells/mm<sup>3</sup>).</p>¤<p>Adjusted for sex, risk group (sex between men, injecting drug use, sex between men and women, other/unknown), age at HIV seroconversion (≤30 and >30 years).</p>¥<p>Long rank test for difference in survivor probabilities.</p>§<p>Cox semiparametric survival model.</p>†<p>Heterogeneity test for categorical variables.</p>‡<p>The symbol “-” for median survival time indicates that fewer than 50% of patients at risk have experienced the event by the end of follow-up.</p>", "links"=>[], "tags"=>["aids", "combinations", "immunological", "definitions"], "article_id"=>851575, "categories"=>["Biological Sciences"], "users"=>["Sara Lodi", "Martin Fisher", "Andrew Phillips", "Andrea De Luca", "Jade Ghosn", "Ruslan Malyuta", "Robert Zangerle", "Santiago Moreno", "Philippe Vanhems", "Faroudy Boufassa", "Marguerite Guiguet", "Kholoud Porter"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0078642.t003", "stats"=>{"downloads"=>0, "page_views"=>3, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Risk_of_AIDS_and_or_death_according_to_combinations_of_clinical_and_immunological_definitions_of_severe_PHI_/851575", "title"=>"Risk of AIDS and/or death according to combinations of clinical and immunological definitions of severe PHI.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2013-11-14 04:36:51"}

PMC Usage Stats | Further Information

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Relative Metric

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