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

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 an...

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Detalles Bibliográficos
Autores: May, Margaret T., Vehreschild, Jorg-Janne, Trickey, Adam|||0000-0003-3462-2898, Obel, Niels|||0000-0002-5031-0045, Reiss, Peter, Bonnet, Fabrice|||0000-0001-9255-8228, Mary-Krause, Murielle, Samji, Hasina, Cavassini, Matthias, Gill, Michael John, Shepherd, Leah C., Crane, Heidi, D'Arminio Monforte, Antonella, Burkholder, Greer A., Johnson, Margaret M., Sobrino-Vegas, Paz, Domingo Pedrol, Pedro|||0000-0003-1138-5770, Zangerle, Robert, Justice, Amy C., Sterling, Timothy R., Miró, José M.|||0000-0001-8057-7755, Sterne, Jonathan A. C.
Tipo de recurso: artículo
Fecha de publicación:2016
País:España
Institución:Universitat Autònoma de Barcelona
Repositorio:Dipòsit Digital de Documents de la UAB
Idioma:inglés
OAI Identifier:oai:ddd.uab.cat:185833
Acceso en línea:https://ddd.uab.cat/record/185833
https://dx.doi.org/urn:doi:10.1093/cid/ciw183
Access Level:acceso abierto
Palabra clave:HIV
CD4 count
Antiretroviral therapy
Mortality
Cohort collaboration
Descripción
Sumario: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.

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