Abstract:
BACKGROUND:CD4 cell count is a strong predictor of the subsequent risk of AIDS or death in HIV-infected patients initiating combination antiretroviral therapy (cART). It is not known whether the rate of CD4 cell decline prior to therapy is related to prognosis and should, therefore, influence the decision on when to initiate cART. METHODS AND FINDINGS:We carried out survival analyses of patients from the 23 cohorts of the CASCADE (Concerted Action on SeroConversion to AIDS and Death in Europe) collaboration with a known date of HIV seroconversion and with at least two CD4 measurements prior to initiating cART. For each patient, a pre-cART CD4 slope was estimated using a linear mixed effects model. Our primary outcome was time from initiating cART to a first new AIDS event or death. We included 2,820 treatment-naïve patients initiating cART with a median (interquartile range) pre-cART CD4 cell decline of 61 (46-81) cells/microl per year; 255 patients subsequently experienced a new AIDS event or death and 125 patients died. In an analysis adjusted for established risk factors, the hazard ratio for AIDS or death was 1.01 (95% confidence interval 0.97-1.04) for each 10 cells/microl per year reduction in pre-cART CD4 cell decline. There was also no association between pre-cART CD4 cell slope and survival. Alternative estimates of CD4 cell slope gave similar results. In 1,731 AIDS-free patients with >350 CD4 cells/microl from the pre-cART era, the rate of CD4 cell decline was also not significantly associated with progression to AIDS or death (hazard ratio 0.99, 95% confidence interval 0.94-1.03, for each 10 cells/microl per year reduction in CD4 cell decline). CONCLUSIONS:The CD4 cell slope does not improve the prediction of clinical outcome in patients with a CD4 cell count above 350 cells/microl. Knowledge of the current CD4 cell count is sufficient when deciding whether to initiate cART in asymptomatic patients. Please see later in the article for the Editors' Summary.
journal_name
PLoS Medjournal_title
PLoS medicineauthors
Wolbers M,Babiker A,Sabin C,Young J,Dorrucci M,Chêne G,Mussini C,Porter K,Bucher HC,CASCADE Collaboration Members.doi
10.1371/journal.pmed.1000239subject
Has Abstractpub_date
2010-02-23 00:00:00pages
e1000239issue
2eissn
1549-1277issn
1549-1676journal_volume
7pub_type
杂志文章相关文献
PLOS MEDICINE文献大全abstract:BACKGROUND:Published research on prescribed opioid analgesic (POA) use during pregnancy and birth outcomes is limited in scope and has not adequately adjusted for potential confounding factors. To help address these gaps, we estimated associations between maternal POAs during pregnancy and two adverse birth outcomes us...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1002980
更新日期:2019-12-02 00:00:00
abstract:BACKGROUND:Stillbirth is strongly related to impaired fetal growth. However, the relationship between fetal growth and stillbirth is difficult to determine because of uncertainty in the timing of death and confounding characteristics affecting normal fetal growth. METHODS AND FINDINGS:We conducted a population-based c...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1001633
更新日期:2014-04-22 00:00:00
abstract:BACKGROUND:Global data indicate that women with a history of hyperglycemia first detected in pregnancy (HFDP) are at up to 7 times risk of progressing to type 2 diabetes mellitus (T2DM) compared with their counterparts who have pregnancies that are not complicated by hyperglycemia. However, there are no data from the s...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1002865
更新日期:2019-09-09 00:00:00
abstract:BACKGROUND:Socioeconomic disparities in infant mortality have persisted for decades in high-income countries and may have become stronger in some populations. Therefore, new understandings of the mechanisms that underlie socioeconomic differences in infant deaths are essential for creating and implementing health initi...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1002831
更新日期:2019-06-14 00:00:00
abstract:BACKGROUND:Diabetes is a well-known risk factor for tuberculosis (TB) and is increasingly prevalent in low- and middle-income countries, where the burden of TB is high. Glycemic control has the potential to modify the risk of TB. However, there are few studies on the association between glycemic control and TB risk, an...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1002072
更新日期:2016-08-09 00:00:00
abstract:BACKGROUND:Quantitative estimation of the extent to which the immune system's protective effect against one herpes simplex virus type 2 (HSV-2) infection protects against infection with additional HSV-2 strains is important for understanding the potential for HSV-2 vaccine development. Using viral genotyping, we estima...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1002475
更新日期:2017-12-27 00:00:00
abstract:BACKGROUND:Bariatric and metabolic surgery is used as a treatment for patients with severe and complex obesity. However, there is a need to improve outcome selection and reporting in bariatric surgery trials. A Core Outcome Set (COS), an agreed minimum set of outcomes reported in all studies of a specific condition, ma...
journal_title:PLoS medicine
pub_type: 指南,杂志文章
doi:10.1371/journal.pmed.1002187
更新日期:2016-11-29 00:00:00
abstract:BACKGROUND:Opioid misuse and deaths are increasing in the United States. In 2017, Ohio had the second highest overdose rates in the US, with the city of Cincinnati experiencing a 50% rise in opioid overdoses since 2015. Understanding the temporal and geographic variation in overdose emergencies may help guide public po...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1002956
更新日期:2019-11-12 00:00:00
abstract::Philippe Calain discusses the health and environmental hazards of extractive industries like mining and explores the tensions that arise when medical humanitarian organizations are called to intervene in emergencies involving the extractive sector. ...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1001302
更新日期:2012-01-01 00:00:00
abstract:BACKGROUND:Ovarian cancer kills approximately 15,000 women in the United States every year, and more than 140,000 women worldwide. Most deaths from ovarian cancer are caused by tumors of the serous histological type, which are rarely diagnosed before the cancer has spread. Rational design of a potentially life-saving e...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1000114
更新日期:2009-07-01 00:00:00
abstract:BACKGROUND:Plasmodium falciparum merozoite surface protein 3 is a malaria vaccine candidate that was identified, characterised, and developed based on a unique immuno-clinical approach. The vaccine construct was derived from regions fully conserved among various strains and containing B cell epitopes targeted by human ...
journal_title:PLoS medicine
pub_type: 临床试验,杂志文章
doi:10.1371/journal.pmed.0020344
更新日期:2005-11-01 00:00:00
abstract::In a Perspective, David Peiris and Dorairaj Prabhakaran discuss implications and challenges of cardiovascular disease risk assessments in the population of India. ...
journal_title:PLoS medicine
pub_type: 评论,杂志文章
doi:10.1371/journal.pmed.1002582
更新日期:2018-06-19 00:00:00
abstract:BACKGROUND:Meta-analyses of antidepressant medications have reported only modest benefits over placebo treatment, and when unpublished trial data are included, the benefit falls below accepted criteria for clinical significance. Yet, the efficacy of the antidepressants may also depend on the severity of initial depress...
journal_title:PLoS medicine
pub_type: 杂志文章,meta分析
doi:10.1371/journal.pmed.0050045
更新日期:2008-02-01 00:00:00
abstract:BACKGROUND TO THE DEBATE:Umbilical cord blood--the blood that remains in the placenta after birth--can be collected and stored frozen for years. A well-accepted use of cord blood is as an alternative to bone marrow as a source of hematopoietic stem cells for allogeneic transplantation to siblings or to unrelated recipi...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.0020044
更新日期:2005-02-01 00:00:00
abstract::[This corrects the article DOI: 10.1371/journal.pmed.1003293.]. ...
journal_title:PLoS medicine
pub_type: 已发布勘误
doi:10.1371/journal.pmed.1003517
更新日期:2020-12-29 00:00:00
abstract:BACKGROUND:At the beginning of June 2020, there were nearly 7 million reported cases of coronavirus disease 2019 (COVID-19) worldwide and over 400,000 deaths in people with COVID-19. The objective of this study was to determine associations between comorbidities listed in the Charlson comorbidity index and mortality am...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1003321
更新日期:2020-09-10 00:00:00
abstract:BACKGROUND:Intimate partner violence (IPV) against women is a major global health issue, particularly in low- and middle-income countries (LMICs), that is associated with poor physical and mental health, but its association with breastfeeding practices is understudied. Both the World Health Organization (WHO) and the U...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1002921
更新日期:2019-10-01 00:00:00
abstract:BACKGROUND:Glioblastoma multiforme (GBM) is the most aggressive primary brain tumor that carries a 5-y survival rate of 5%. Attempts at eliciting a clinically relevant anti-GBM immune response in brain tumor patients have met with limited success, which is due to brain immune privilege, tumor immune evasion, and a pauc...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1000010
更新日期:2009-01-13 00:00:00
abstract:BACKGROUND:Nutritional supplements may improve development of infants born small (preterm or small for gestational age [SGA]) but may increase the risk of later metabolic disease. We conducted a systematic review and meta-analysis to assess the effects of macronutrient supplements for infants born small on later develo...
journal_title:PLoS medicine
pub_type: 杂志文章,meta分析
doi:10.1371/journal.pmed.1002952
更新日期:2019-10-30 00:00:00
abstract:BACKGROUND:Bilharzia is one of the major parasitic infections affecting the public health and socioeconomic circumstances in (sub) tropical areas. Its causative agents are schistosomes. Since these worms remain in their host for decades, they have developed mechanisms to evade or resist the immune system. Like several ...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.0030253
更新日期:2006-08-01 00:00:00
abstract:BACKGROUND:The response to the next influenza pandemic will likely include extensive use of antiviral drugs (mainly oseltamivir), combined with other transmission-reducing measures. Animal and in vitro studies suggest that some strains of influenza may become resistant to oseltamivir while maintaining infectiousness (f...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.0040015
更新日期:2007-01-01 00:00:00
abstract:BACKGROUND:WHO recommends prompt diagnosis and quinine plus clindamycin for treatment of uncomplicated malaria in the first trimester and artemisinin-based combination therapies in subsequent trimesters. We undertook a systematic review of women's access to and healthcare provider adherence to WHO case management polic...
journal_title:PLoS medicine
pub_type: 杂志文章,meta分析,评审
doi:10.1371/journal.pmed.1001688
更新日期:2014-08-05 00:00:00
abstract:BACKGROUND:The identification and characterization of tumor suppressor genes has enhanced our understanding of the biology of cancer and enabled the development of new diagnostic and therapeutic modalities. Whereas in past decades, a handful of tumor suppressors have been slowly identified using techniques such as link...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.0050114
更新日期:2008-05-27 00:00:00
abstract:BACKGROUND:While patterns of incidence of clinical influenza have been well described, much uncertainty remains over patterns of incidence of infection. The 2009 pandemic provided both the motivation and opportunity to investigate patterns of mild and asymptomatic infection using serological techniques. However, to dat...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1000442
更新日期:2011-06-01 00:00:00
abstract::H. Bart van der Worp and colleagues discuss the controversies and possibilities of translating the results of animal experiments into human clinical trials. ...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1000245
更新日期:2010-03-30 00:00:00
abstract:BACKGROUND:There is growing concern that racial and ethnic minority communities around the world are experiencing a disproportionate burden of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and coronavirus disease 2019 (COVID-19). We investigated racial and ethnic disparities in patterns of COVI...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1003379
更新日期:2020-09-22 00:00:00
abstract:BACKGROUND:Obstructive sleep apnea (OSA) has been reported to be a risk factor for cardiovascular (CV) disease. Although the apnea-hypopnea index (AHI) is the most commonly used measure of OSA, other less well studied OSA-related variables may be more pathophysiologically relevant and offer better prediction. The objec...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1001599
更新日期:2014-02-04 00:00:00
abstract:BACKGROUND:agricultural pesticide poisoning is a major public health problem in the developing world, killing at least 250,000-370,000 people each year. Targeted pesticide restrictions in Sri Lanka over the last 20 years have reduced pesticide deaths by 50% without decreasing agricultural output. However, regulatory de...
journal_title:PLoS medicine
pub_type: 杂志文章,多中心研究
doi:10.1371/journal.pmed.1000357
更新日期:2010-10-26 00:00:00
abstract:BACKGROUND:Through major efforts to reduce costs and expand access to antiretroviral therapy worldwide, widespread delivery of effective treatment to people living with HIV/AIDS is now conceivable even in severely resource-constrained settings. However, the potential epidemiologic impact of treatment in the context of ...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.0020016
更新日期:2005-01-01 00:00:00
abstract:BACKGROUND:Global warming is predicted to indirectly result in more undernutrition by threatening crop production. Whether temperature rise could affect undernutrition directly is unknown. We aim to quantify the relationship between short-term heat exposure and risk of hospitalization due to undernutrition in Brazil. ...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1002950
更新日期:2019-10-29 00:00:00