Effectiveness of ART
Gary Stein
exist...................................
TITLE: Decreased morbidity and mortality among HIV+ individuals
following initiation of antiretroviral therapy.
AUTHORS: Hogg RS; Yip B; Heath KV; Craib KJ; Schechter MT;
O'Shaughnessy MV; Montaner JS
AUTHOR AFFILIATION: BC Centre for Excellence in HIV/AIDS, Vancouver,
British Columbia, Canada.
SOURCE: Conf Retroviruses Opportunistic Infect. 1998 Feb 1-5;5th:115
(abstract no. 197).
SECONDARY SOURCE ID: AIDS/98929123
ABSTRACT:
Objective: To characterize survival following the initiation of
antiretroviral therapy (ARV) among HIV+ individuals in BC.
Methods: In BC, ARV therapies are distributed free according to
specific therapeutic guidelines. Our analysis was based on all HIV+
individuals aged greater than 18 years who were first prescribed with
any ARV between 10/92 and 06/96. We restricted the analysis to
subjects with CD4 cell counts less than or equal to 350 cell mm3, to
ensure individuals were eligible for combination ARV over the entire
study period. A comparison of rates of progression from initiation of
ARV to death or a primary AIDS diagnosis for subjects who initially
received ZDV, ddI, ddC based therapy (ERA-I), and those who initially
received double combination therapy regimens including 3TC or d4T
(ERA-II).
Results: A combination therapy regimens including 3TC or d4T (ERA-II).
(Figure: see text) Results: A total of 1,178 (951 ERA-I, 227 ERA-II)
individuals were eligible. As of 06/30/97, there were a total of 390
deaths (367 ERA-I, 23 ERA-II). The cumulative mortality rate at 15
months were 17.1% (plus or minus 1.2%) and 10.0% (plus or minus 2.0%)
for ERA-I and ERA-II subjects respectively (p = 0.004). After
adjusting for PCP and MAC prophylaxis use, AIDS diagnosis, CD4
count,gender and age, ERA-I participants were 1.9 times (95% CI: 1.2,
3.0; p = 0.003) more likely to die than those in ERA-II. Multivariate
analysis also demonstrated that AIDS-free ERA-I participants were 2.5
times (95% CI: 1.6, 3.9; p less than 0.001) more likely to progress to
AIDS or death than those in ERA-II.
Conclusion: Our analysis demonstrated a significant reduction in
mortality and AIDS-free survival for HIV infected individuals who
initiated therapy with regimens including d4T or 3TC.
TITLE: The effect of attenuating CD4 decline on subsequent
hospitalization: potential benefit of viral load driven antiretroviral
therapy.
AUTHORS: Anis Aslam H; Hogg RS; Wang X; Yip B; Montaner JS;
O'Shaughnessy MV; Schechter MT
AUTHOR AFFILIATION: Canadian HIV Trials Network, Canada.
SOURCE: Conf Retroviruses Opportunistic Infect. 1997 Jan
22-26;4th:112 (abstract no. 263).
SECONDARY SOURCE ID: AIDS/97926488
ABSTRACT:
Objective: To determine the potential economic benefit of stabilizing
CD4/viral load levels on reducing hospitalization in a large
population-based cohort of HIV-positive adult men and women.
Methods: Observational, population based cohort study using
time-series data (1991-1995). Study subjects were men and women
enrolled in a province-wide HIV/AIDS drug treatment program and who
had given consent to access their hospitalization records. Patients
with initial counts between 200-500 were stratified as decliners (D)
if their CD4 count had declined by at least 10% over a baseline 6
month period and were non-decliners (ND) otherwise. Hospitalization
patterns following this period were assessed according to total,
maximum and average number of days of hospitalizations per 100 days in
the program by univariate and multivariate (ANOVA) methods.
Results: D=171 and ND=280. There was no significant difference in
initial CD4 (D=343, ND=351) between the 2 groups (p=0.3).
Hospitalization frequency (0.22 vs. 0.11; p=0.000), total days (1.81
vs. 0.73; p=0.000), maximum days (1.06) vs. 0.38; p=0.000) and mean
days (0.58 vs. 0.24; p=0.000) were all greater for the D group in the
follow-up period. Multivariate models using each of the above measures
of hospitalization as the dependent variable showed that the D group
had more frequent and longer hospitalizations than ND when controlling
for prior AIDS and gender.
Conclusion: Our results show that individuals with stable CD4 counts
have significantly lower hospitalization and highlights the potential
economic impact of viral load driven antiretroviral therapy aimed at
attenuating the time path of decline in CD4 counts. We are currently
calculating the exact dollar amount of cost saving from reduced
hospitalizations and the cost-effectiveness of the newer
antiretrovirals and associated viral load testing costs after
accounting for hospitalization savings.
TITLE: Improved survival among men and women on triple antiretroviral
therapy.
AUTHORS: Hogg R; Yip B; Craib KJ; Schechter MT; O'Shaughnessy MV;
Montaner JS
AUTHOR AFFILIATION: BC Centre for Excellence in HIV/AIDS, Vancouver,
Canada.
SOURCE: Int Conf AIDS. 1998;12:68 (abstract no. 12278).
SECONDARY SOURCE ID: ICA12/98387053
ABSTRACT:
OBJECTIVE: To characterize survival following the initiation of double
and triple combination antiretroviral (ARV) therapy among HIV+
individuals with free access to ARV medications.
METHODS: In BC, antiretroviral therapies are distributed free of
charge according to specific therapeutic guidelines. Study subjects
were antiretroviral naive, initially prescribed any combination of 2
NRTIs including either d4T or 3TC (ERA-II) from 06/93-06/96 or 2 NRTIs
and a PI (ERA-III) from 01/96-12/96. The outcomes in this analysis
were death and a primary diagnosis of AIDS. Statistical methods
followed the intent-to-treat principle with subjects being retained in
their initial treatment groups. Primary and secondary outcomes were
examined from the start of ARV therapy. Survival analyses were
conducted using K-M methods. Event free subjects were right censored
at 30/06/97 and 12/31/97 for ERA-II and ERA-III respectively or at
last known contact.
RESULTS: A total of 520 (376 ERA-II, 144 ERA-III) men and women were
eligible for this analysis. As of 12/31/97, there were a total of 44
deaths (41 ERA-II, 3 ERA-III), yielding a crude mortality rate of
8.5%. Product limit estimates of the cumulative mortality rate at one
year were 8.3% (+/- 1.4%) and 2.1% (+/- 1.1%) for ERA-II and ERA-III
subjects respectively (p = 0.004). After adjusting for AIDS diagnosis,
CD4 cell count, gender and age in a multivariate model, ERA-II
participants were 4.79 times (95% CI: 1.47, 15.65; p = 0.009) more
likely to die than those in ERA-III after antiretroviral therapy
initiation. In our second multivariate model we restricted our
analysis to 413 AIDS-free individuals. Again after adjusting for the
CD4 cell count, gender and age, we found ERA-II 3.78 times more likely
to die or progress to AIDS (95% CI: 1.15, 12.40; p = 0.028 than
ERA-III subjects.
CONCLUSION: Our analysis demonstrates, in a population-based study of
participants enrolled in a province-wide anti-HIV treatment program, a
significant reduction in mortality and AIDS-free survival for those
individuals initiated on triple drug therapy. These results remain
significant even after adjusting for a number of salient
characteristics including baseline AIDS, CD4 cell count, gender and
age. Overall, our results demonstrate the effectiveness of triple drug
therapy regimens outside the context of a large scale clinical trial.
TITLE: Markedly declining incidence of AIDS in persons treated with
antiretroviral therapy from 1994-1996.
AUTHORS: Hogg R; Phillips P; Forrest D; Montessori V; Raboud J;
Schechter MT; Montaner JS
AUTHOR AFFILIATION: B.C. Centre for Excellence in HIV/AIDS,
Vancouver, Canada.
SOURCE: Int Conf AIDS. 1998;12:39 (abstract no. 12142).
SECONDARY SOURCE ID: ICA12/98385299
ABSTRACT:
OBJECTIVE: To characterize the changing incidence and spectrum of AIDS
defining illnesses (ADI) in HIV-infected individuals taking
antiretroviral (ARV) therapy during the period prior to and since the
introduction of newer ARV agents.
METHODS: This study was based on retrospective analysis of individuals
enrolled in a population-based Drug Treatment Program in BC, who were
taking ARV therapy between 01/94-12/96. Data on ADIs were gathered on
all study subjects through physician reports and record linkages.
Rates were expressed as the number of AIDS primary diagnoses per 1,000
active participants and were calculated for every six months over the
three year period from 01/94-12/96. Events were recorded for all ADIs
(principally PCP, KS, candidal infections, MAC, CMV, dementia,
neurologic illnesses, and wasting syndrome) and the rate of decline
for each was calculated and compared. The relative proportion of
different ADIs was compared for 1995 and 1996 relative to baseline in
1994.
RESULTS: A total of 367 ADI cases were diagnosed among 2,580 study
participants between 01/94-2/96. At the time of diagnosis the median
age was 39 years (IQR = 34-45 years) and CD4 cell was 0.070 x 10(9)
cells/L (IQR = 0.030-0.130 x 10(9) cells/L). In the first 6 months of
1994, there were 109 cases of ADI diagnosed per 1,000 participants.
This rate had declined 83% by the last six months of 1996 to 16 per
1,000 participants. The incidence of ADIs decreased at a rate of 19
cases per 1,000 participants per semester from 1994 to 1996 (p =
0.001) with a sharp decline in 1995 and 1996 of 26 cases per 1,000
participants per semester in those two years (p = 0.011). There was no
statistically significant change in the spectrum of ADIs over the
period of study with PCP and KS remaining the most common.
CONCLUSION: Our data demonstrates that there has been a substantial
decrease in the incidence of ADIs from 1994 to 1996 among individuals
prescribed ARV agents in a population-based anti-HIV treatment
program. This decrease has accelerated since 1995. However, despite
this overall decline in incidence of ADIs, the spectrum of ADIs and
their relative frequency has not changed substantially over the study
period.
TITLE: Impact of antiretroviral use on survival in a large Brazilian
seroprevalent cohort.
AUTHORS: de Lima LA; Neto PG; Pacheco AG; Faccio MR; Neto JS; Moulton
LH; Harrison LH; Schechter M
AUTHOR AFFILIATION: Hospital Universitario, Universidade Federal do
Rio de Janeiro, Brazil. Fax: 55(21) 590-1615. E-mail:
Maur...@Omega.LNCC.Br.
SOURCE: Int Conf AIDS. 1996 Jul 7-12;11(2):80 (abstract no.
We.B.3138).
SECONDARY SOURCE ID: ICA11/96923493
ABSTRACT:
Objective: To evaluate the effectiveness of antiretroviral treatment
for mortality reduction in a large cohort of HIV- infected patients in
Rio de Janeiro, Brazil.
Methods: We prospectively collected data on participants of a cohort
study whose objective is to validate the World Health Organization
(WHO) staging system for HIV infection in a developing country. For
the present study, inclusion criteria were being in WHO stages I, II,
or III at entry into the cohort, having at least one CD4 lymphocyte
analysis prior to development of AIDS, and not having been previously
treated with antiretroviral drugs. We analyzed time-until-death via
multivariable Cox regression models with time-dependent covariates for
first ZDV or DDI use and PCP and TB prophylaxis, closely controlling
for initial CD4% and time since first known HIV seropositivity.
Results: 538 patients met the study criteria; 370 (69%) were male; 26
(5%) were in the transfusion risk group and 14 (3%) were IDUs. At
study entry, the median CD4% was 20; 373 (69%), 89 (17%), and 74 (14%)
patients were in stages I, II and III, respectively; 219 cohort
participants (41%) received ZDV at some point, 91% of them (198)
before having a diagnosis of AIDS. At the time of ZDV prescription,
the median CD4% was 12; 90 (41%) were in stage I (median CD4%=14), 56
(26%) in stage II (median CD4%=14), 52 (24%) in stage III (median
CD4%=10) and 21 (9%) in stage IV (median CD4%=7). The median follow-up
time from study entry was 22.3 months. There were 76 deaths. Usage of
ZDV before the diagnosis of AIDS was associated with a decreased
mortality in the ensuing two years (RR=.54, 95% CI=.27-1.1). However,
this protective effect diminished over time (overall RR=.99, 95%
CI=.59-1.7). Use of other antiretrovirals (DDI or DDC) lowered
mortality (RR=.41, 95% CI=.16, 1.0). Cotrimoxazol use was
independently associated with a lower mortality (RR=.47, 95%
CI=.20-1.1).
Conclusions: To our knowledge, this is the first large study to
evaluate the effectiveness of antiretroviral therapy in a developing
country. The encountered time limited effectiveness of ZDV use in
mortality reduction is similar to what has been described in developed
countries. Although the synergistic effects of drug combinations could
not be evaluated, since only 15 patients who received DDI or DDC did
not receive ZDV, use of DDI or DDC was associated with a lower
mortality. This study was supported by grants from the Brazilian
Ministry of Health and Petrobras SA.
--
Gary Stein
ges...@starpower.net
http://www.mischealthaids.org
"Usenet is like a herd of performing elephants with diarrhea
massive, difficult to redirect, awe-inspiring, entertaining, and
a source of mind- boggling amounts of excrement when you least expect
it."
(Gene Spafford)
fred
Pharmaceutical Industry Usenet Infiltrator
"Gary Stein" <ges...@starpower.net> lies:
>Of course the denialists claim these studies don't
>exist...................................
Standard pharmaceutical industry infiltrator revisionism.
Fact is, as all can plainly see, these trash
studies simply don't exist in the peer-reviewed
biomedical literature for one simple reason:
nobody would publish them because they reek
of fraud, misinformation (and yes, many are
simply fabricated).
These drug conference "puff pieces" represent nothing more
than a beauty contest amongst weasles who grovel for
their precious junk science "research" grants:
>TITLE: Decreased morbidity and mortality among HIV+ individuals
>following initiation of antiretroviral therapy.
>AUTHORS: Hogg RS; Yip B; Heath KV; Craib KJ; Schechter MT;
>O'Shaughnessy MV; Montaner JS
>AUTHOR AFFILIATION: BC Centre for Excellence in HIV/AIDS, Vancouver,
>British Columbia, Canada.
>SOURCE: Conf Retroviruses Opportunistic Infect. 1998 Feb 1-5;5th:115
>(abstract no. 197).
>SECONDARY SOURCE ID: AIDS/98929123
Another example of outrageous junk science:
>TITLE: Markedly declining incidence of AIDS in persons treated with
>antiretroviral therapy from 1994-1996.
>AUTHORS: Hogg R; Phillips P; Forrest D; Montessori V; Raboud J;
>Schechter MT; Montaner JS
>AUTHOR AFFILIATION: B.C. Centre for Excellence in HIV/AIDS,
>Vancouver, Canada.
>SOURCE: Int Conf AIDS. 1998;12:39 (abstract no. 12142).
>SECONDARY SOURCE ID: ICA12/98385299
>ABSTRACT:
>
>OBJECTIVE: To characterize the changing incidence and spectrum of AIDS
>defining illnesses (ADI) in HIV-infected individuals taking
>antiretroviral (ARV) therapy during the period prior to and since the
>introduction of newer ARV agents.
These crooked murdering drug company bastards don't bother
mentioning the decline in HIV infections of a decade earlier
leading to fewer people with AIDS and the massive AZT-induced
die-offs that preceded the time frame in question.
How utterly degenerate of Gary Stein for his failure to cite
ANY evidence for his false claims from the peer-reviewed
biomedical journals for his pharmaceutical industry spoon-fed
lies and paid public relations spin on this newsgroup.
fred