Long-term effectiveness of potent antiretroviral therapy in preventing AIDS and death: a prospective cohort study
The LancetPublished 1 July 2005
Jonathan A C Sterne, Miguel A. Hernán, Bruno Ledergerber, Kate Tilling, Rainer Weber, Pedram Sendi
Citations558
SJR quartileQ1
SJR score12.11
SNIP22.72
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TL;DR
The results, which are appropriately controlled for confounding by indication, are consistent with reported declines in rates of AIDS and death in developed countries, and provide a context in which to consider adverse effects of HAART.
Abstract
Our results, which are appropriately controlled for confounding by indication, are consistent with reported declines in rates of AIDS and death in developed countries, and provide a context in which to consider adverse effects of HAART.
Keywords
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