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Antiretroviral treatment regardless of CD4 count: the universal answer to a contextual question

Overview of attention for article published in AIDS Research and Therapy, January 2016
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Title
Antiretroviral treatment regardless of CD4 count: the universal answer to a contextual question
Published in
AIDS Research and Therapy, January 2016
DOI 10.1186/s12981-016-0111-1
Pubmed ID
Authors

Serge P. Eholié, Serge P. Eholié, Anani Badje, Gérard M. Kouame, Jean-Baptiste N’takpe, Raoul Moh, Christine Danel, Xavier Anglaret

Abstract

After a period where it was recommended to start antiretroviral therapy (ART) early, the CD4 threshold for treating asymptomatic adults dropped to 200/mm(3) at the beginning of the 2000s. This was mostly due to a great prudence with regards to drug toxicity. The ART-start CD4 threshold in most international guidelines was then raised to 350/mm(3) in 2006-2009 and to 500/mm(3) in 2009-2013. Between 2012 and 2015, international guidelines went the last step further and recommended treating all HIV-infected adults regardless of their CD4 count. This ultimate step was justified by the results of three randomized controlled trials, HPTN 052, Temprano ANRS 12136 and START. These three trials assessed the benefits and risks of starting ART immediately upon inclusion ("early ART") versus deferring ART until the current starting criteria were met ("deferred ART"). Taken together, they recruited 8427 HIV-infected adults in 37 countries. The primary outcome was severe morbidity, a composite outcome that included all-cause deaths, AIDS diseases, and non-AIDS cancers in the three trials. The trial results were mutually consistent and reinforcing. The overall risk of severe morbidity was significantly 44-57 % lower in patients randomized to early ART as compared to deferred ART. Early ART also decreased the risk of AIDS, tuberculosis, invasive bacterial diseases and Kaposi's sarcoma considered separately. The incidence of severe morbidity was 3.2 and 3.5 times as high in HPTN052 and Temprano as in START, respectively. This difference is mostly due to the geographical context of morbidity. The evidence is now strong that initiating ART at high CD4 counts entails individual benefits worldwide, and that this is all the more true in low resource contexts where tuberculosis and other bacterial diseases are highly prevalent. These benefits in addition to population benefits consisting of preventing HIV transmission demonstrated in HPTN052, justify the recommendation that HIV-infected persons should initiate ART regardless of CD4 count. This recommendation faces many challenges, including the fact that switching from "treat at 500 CD4/mm(3)" to "treat everyone" not only requires more tests and more drugs, but also more people to support patients and help them remain in care.

Twitter Demographics

The data shown below were collected from the profile of 1 tweeter who shared this research output. Click here to find out more about how the information was compiled.

Mendeley readers

The data shown below were compiled from readership statistics for 99 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Unknown 99 100%

Demographic breakdown

Readers by professional status Count As %
Student > Master 27 27%
Researcher 14 14%
Student > Bachelor 13 13%
Student > Postgraduate 8 8%
Student > Doctoral Student 6 6%
Other 12 12%
Unknown 19 19%
Readers by discipline Count As %
Medicine and Dentistry 30 30%
Nursing and Health Professions 12 12%
Immunology and Microbiology 7 7%
Social Sciences 6 6%
Psychology 5 5%
Other 18 18%
Unknown 21 21%

Attention Score in Context

This research output has an Altmetric Attention Score of 1. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 26 July 2016.
All research outputs
#4,314,447
of 8,133,552 outputs
Outputs from AIDS Research and Therapy
#181
of 270 outputs
Outputs of similar age
#141,434
of 257,634 outputs
Outputs of similar age from AIDS Research and Therapy
#5
of 7 outputs
Altmetric has tracked 8,133,552 research outputs across all sources so far. This one is in the 27th percentile – i.e., 27% of other outputs scored the same or lower than it.
So far Altmetric has tracked 270 research outputs from this source. They receive a mean Attention Score of 3.2. This one is in the 15th percentile – i.e., 15% of its peers scored the same or lower than it.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 257,634 tracked outputs that were published within six weeks on either side of this one in any source. This one is in the 35th percentile – i.e., 35% of its contemporaries scored the same or lower than it.
We're also able to compare this research output to 7 others from the same source and published within six weeks on either side of this one. This one has scored higher than 2 of them.