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

• Authors: Margaret T. May, University of Bristol; Jorg-Janne Vehreschild, University of Cologne; Adam Trickey, University of Bristol; Niels Obel, Copenhagen University Hospital; Peter Reiss, University of Amsterdam; Fabrice Bonnet, Bordeaux University Hospital; Murielle Mary-Krause, University of Paris 06; Hasina Samji, British Columbia Centre for Excellence in HIV/AIDS; Matthias Cavassini, Lausanne University Hospital; Michael John Gill, University of Calgary; Leah C. Shepherd, University College London; Heidi M. Crane, University of Washington; Antonella d'Arminio Monforte, University of Milan; Greer A. Burkholder, University of Alabama Birmingham; Margaret M. Johnson, Royal Free London NHS Foundation Trust; Paz Sobrino-Vegas, Instituto de Salud Carlos III; Pere Domingo, Autonomous University of Barcelona; Robert Zangerle, Medical University of Innsbruck; Amy C. Justice, Yale University; Timothy R. Sterling, Vanderbilt University; Jose M. Miro, University of Barcelona; Jonathan A.C. Sterne, University of Bristol; Jodie L. Guest, Emory University
• Journal Title: Clinical Infectious Diseases
• Volume: Volume 62, Number 12
• Publisher: Oxford University Press (OUP): Policy B - Oxford Open Option C | 2016-06-15, Pages 1571-1577
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1093/cid/ciw183
• Subjects: Health Sciences, Immunology; Biology, Microbiology; Health Sciences, Public Health
• Keywords: Science & Technology; Life Sciences & Biomedicine; Immunology; Infectious Diseases; Microbiology; HIV; CD4 count; antiretroviral therapy; mortality; cohort collaboration; T-CELL RECOVERY; HIV-1-INFECTED PATIENTS; SURVIVAL; INITIATION; PROGNOSIS; INTENSIFICATION; MARAVIROC; PREDICT; RISK; TIME

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.