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Clin Infect Dis. 2016 Jun 15;62(12):1571-1577. doi: 10.1093/cid/ciw183. Epub 2016 Mar 29.

Mortality According to CD4 Count at Start of Combination Antiretroviral Therapy Among HIV-infected Patients Followed for up to 15 Years After Start of Treatment: Collaborative Cohort Study.

Author information

1
Schoolof Social and Community Medicine, University of Bristol, United Kingdom.
2
Clinical Trials Unit II Infectious Diseases, University of Cologne, Germany.
3
Department of Infectious Diseases, Copenhagen University Hospital, Denmark.
4
Department of Global Health, Academic Medical Center, University of Amsterdam, and Amsterdam Institute of Global Health and Development HIV Monitoring Foundation.
5
Department of Internal Medicine, Division of Infectious Diseases, Center for Infection and Immunity-Amsterdam, Academic Medical Center, The Netherlands.
6
Bordeaux University, ISPED, INSERM U897.
7
CHU de Bordeaux.
8
Sorbonne Universités, UPMC Université Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France.
9
Division of Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.
10
Service of Infectious Diseases, Lausanne University Hospital and University of Lausanne, Switzerland.
11
Division of Infectious Diseases, University of Calgary, Canada.
12
Research Department of Infection and Population Health, University College London Medical School, United Kingdom.
13
Center for AIDS Research, University of Washington, Seattle.
14
Monforte Clinic of Infectious Diseases and Tropical Medicine, San Paolo Hospital, University of Milan, Italy.
15
Division of Infectious Disease, Department of Medicine, University of Alabama, Birmingham.
16
Department of HIV Medicine, Royal Free London NHS Foundation Trust, United Kingdom.
17
Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid.
18
Department of Medicine, Autonomous University of Barcelona, Spain.
19
Medical University Innsbruck, Austria.
20
Yale University School of Medicine, New Haven.
21
Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut.
22
Vanderbilt University School of Medicine, Nashville, Tennessee.
23
Hospital Clinic-IDIBAPS, University of Barcelona, Spain.

Abstract

BACKGROUND:

CD4 count at start of combination antiretroviral therapy (ART) is strongly associated with short-term survival, but its association with longer-term survival is less well characterized.

METHODS:

We estimated mortality rates (MRs) by time since start of ART (<0.5, 0.5-0.9, 1-2.9, 3-4.9, 5-9.9, and ≥10 years) among patients from 18 European and North American cohorts who started ART during 1996-2001. Piecewise exponential models stratified by cohort were used to estimate crude and adjusted (for sex, age, transmission risk, period of starting ART [1996-1997, 1998-1999, 2000-2001], and AIDS and human immunodeficiency virus type 1 RNA at baseline) mortality rate ratios (MRRs) by CD4 count at start of ART (0-49, 50-99, 100-199, 200-349, 350-499, ≥500 cells/µL) overall and separately according to time since start of ART.

RESULTS:

A total of 6344 of 37 496 patients died during 359 219 years of follow-up. The MR per 1000 person-years was 32.8 (95% confidence interval [CI], 30.2-35.5) during the first 6 months, declining to 16.0 (95% CI, 15.4-16.8) during 5-9.9 years and 14.2 (95% CI, 13.3-15.1) after 10 years' duration of ART. During the first year of ART, there was a strong inverse association of CD4 count at start of ART with mortality. This diminished over the next 4 years. The adjusted MRR per CD4 group was 0.97 (95% CI, .94-1.00; P = .054) and 1.02 (95% CI, .98-1.07; P = .32) among patients followed for 5-9.9 and ≥10 years, respectively.

CONCLUSIONS:

After surviving 5 years of ART, the mortality of patients who started ART with low baseline CD4 count converged with mortality of patients with intermediate and high baseline CD4 counts.

KEYWORDS:

CD4 count; HIV; antiretroviral therapy; cohort collaboration; mortality

PMID:
27025828
PMCID:
PMC4885653
DOI:
10.1093/cid/ciw183
[Indexed for MEDLINE]
Free PMC Article

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