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
CID
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
Margaret T. May 15
Jorg-Janne Vehreschild 14
Adam Trickey 15
Niels Obel 12
Peter Reiss 19 20
Fabrice Bonnet 17 18
Murielle Mary-Krause 22
Hasina Samji 21
Matthias Cavassini 16
Michael John Gill 9
Leah C. Shepherd 10
Heidi M. Crane 7
Antonella d'Arminio Monforte 8
Greer A. Burkholder 5
Margaret M. Johnson 6
Paz Sobrino-Vegas 2
Pere Domingo 4
Robert Zangerle 0
Amy C. Justice 11 13
Timothy R. Sterling 1
José M. Miró 3
Jonathan A. C. Sterne 15
for the Antiretroviral Therapy Cohort Collaboration (ART-CC)
0 Medical University Innsbruck , Austria
1 Vanderbilt University School of Medicine , Nashville, Tennessee
2 Centro Nacional de Epidemiología, Instituto de Salud Carlos III , Madrid
3 Hospital Clinic-IDIBAPS, University of Barcelona , Spain
4 Department of Medicine, Autonomous University of Barcelona , Spain
5 Division of Infectious Disease, Department of Medicine, University of Alabama , Birmingham
6 Department of HIV Medicine, Royal Free London NHS Foundation Trust , United Kingdom
7 Center for AIDS Research, University of Washington , Seattle
8 Monforte Clinic of Infectious Diseases and Tropical Medicine, San Paolo Hospital, University of Milan , Italy
9 Division of Infectious Diseases, University of Calgary , Canada
10 Research Department of Infection and Population Health, University College London Medical School , United Kingdom
11 Veterans Affairs Connecticut Healthcare System , West Haven, Connecticut
12 Department of Infectious Diseases, Copenhagen University Hospital , Denmark
13 Yale University School of Medicine , New Haven
14 Clinical Trials Unit II Infectious Diseases, University of Cologne , Germany
15 School of Social and Community Medicine, University of Bristol , United Kingdom
16 Service of Infectious Diseases, Lausanne University Hospital and University of Lausanne , Switzerland
17 CHU de Bordeaux
18 Bordeaux University , ISPED, INSERM U897
19 Department of Internal Medicine, Division of Infectious Diseases , Center for Infection and Immunity-Amsterdam , Academic Medical Center , The Netherlands
20 Department of Global Health, Academic Medical Center, University of Amsterdam, and Amsterdam Institute of Global Health and Development HIV Monitoring Foundation
21 Division of Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS , Vancouver , Canada
22 Sorbonne Universités, UPMC Université Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136) , Paris , France
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.
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HIV/AIDS
inhibitor has substantially improved the prognosis of human
immunodeficiency virus type 1 (HIV-1)–infected patients
since its introduction in high-income settings in 1996 [
1
].
ART suppresses HIV-1 replication, leading to declines in
plasma HIV-1 RNA, increased CD4 T-cell counts, and, eventually,
decreased morbidity and mortality [
2
]. Because patients have
now been treated with ART for up to 20 years, it is of major
interest to explore predictors of long-term prognosis.
The Antiretroviral Therapy Cohort Collaboration (ART-CC)
was initiated in 2000 by investigators from HIV cohort studies
in North America and Euro (...truncated)