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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
May, Margaret T.
Vehreschild, Jorg-Janne
Trickey, Adam
Obel, Niels
Reiss, Peter
Bonnet, Fabrice
Mary-Krause, Murielle
Samji, Hasina
Cavassini, Matthias
Gill, Michael John
Shepherd, Leah C.
Crane, Heidi M.
d'Arminio Monforte, Antonella
Burkholder, Greer A.
Johnson, Margaret M.
Sobrino-Vegas, Paz
Domingo, Pere (Domingo Pedrol)
Zangerle, Robert (Universitat Autònoma de Barcelona. Departament de Medicina)
Justice, Amy C.
Sterling, Timothy R.
Miró, José M.
Sterne, Jonathan A. C.

Date: 2016
Abstract: The strong association of CD4 count at start of combination therapy with subsequent survival in HIV-infected patients diminished during the first 5 years of treatment. After 5 years, lower baseline CD4 counts were not associated with higher mortality. 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.
Note: Número d'acord de subvenció ISCIII/ISCIII-RETIC RD06-00
Rights: Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original. Creative Commons
Language: Anglès
Document: article ; recerca ; publishedVersion
Subject: HIV ; CD4 count ; Antiretroviral therapy ; Mortality ; Cohort collaboration
Published in: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America, Vol. 62 (march 2016) , p. 1571-1577, ISSN 1537-6591

DOI: 10.1093/cid/ciw183
PMID: 27025828

7 p, 259.3 KB

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Articles > Research articles
Articles > Published articles

 Record created 2018-02-07, last modified 2020-08-09

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