6533b7d9fe1ef96bd126cf1d

RESEARCH PRODUCT

A decision tree to help determine the best timing and antiretroviral strategy in HIV-infected patients.

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SUMMARYOptimal antiretroviral strategies for HIV-infected patients still need to be established. To this end a decision tree including different antiretroviral strategies that could be adopted for HIV-infected patients was built. A 10-year follow-up was simulated by using transitional probabilities estimated from a large cohort using a time-homogeneous Markov model. The desired outcome was for patients to maintain a CD4 cell count of >500 cells/mm3without experiencing AIDS or death. For patients with a baseline HIV viral load ⩾5 log10copies/ml, boosted protease inhibitor-based immediate highly active antiretroviral therapy (HAART) allowed them to spend 12% more time with CD4 ⩾500/mm3than did delayed HAART (6·40vs. 5·69 and 5·57vs. 4·90 years for baseline CD4 ⩾500 and 350–499/mm3, respectively). In patients with a baseline HIV viral load ⩽3·5 log10copies/ml, delayed HAART performed better than immediate HAART (6·43vs. 6·26 and 5·95vs. 5·18 for baseline CD4 ⩾500 and 350–499/mm3, respectively). Immediate HAART is beneficial in patients with a baseline HIV viral load ⩾5 log10copies/ml, whereas deferred HAART appears to be the best option for patients with CD4 ⩾350/mm3and baseline HIV viral load <3·5 log10copies/ml.