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. 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

Margaret T May  1 , Jorg-Janne Vehreschild  2 , Adam Trickey  1 , Niels Obel  3 , Peter Reiss  4   5 , Fabrice Bonnet  6   7 , Murielle Mary-Krause  8 , Hasina Samji  9 , Matthias Cavassini  10 , Michael John Gill  11 , Leah C Shepherd  12 , Heidi M Crane  13 , Antonella d'Arminio Monforte  14 , Greer A Burkholder  15 , Margaret M Johnson  16 , Paz Sobrino-Vegas  17 , Pere Domingo  18 , Robert Zangerle  19 , Amy C Justice  20   21 , Timothy R Sterling  22 , José M Miró  23 , Jonathan A C Sterne  1 ; Antiretroviral Therapy Cohort Collaboration (ART-CC); Andrew Boulle, Christoph Stephan, Jose M Miro, Matthias Cavassini, Geneviève Chêne, Dominique Costagliola, François Dabis, Antonella D'Arminio Monforte, Julia Del Amo, Ard Van Sighem, Gerd Fätkenheuer, John Gill, Jodie Guest, David Hans-Ulrich Haerry, Robert Hogg, Amy Justice, Leah Shepherd, Neils Obel, Heidi Crane, Colette Smith, Peter Reiss, Michael Saag, Tim Sterling, Ramon Teira, Matthew Williams, Robert Zangerle, Jonathan Sterne, Margaret May, Suzanne Ingle, Adam Trickey
Affiliations

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 et al. Clin Infect Dis. .

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.

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Figures

Figure 1.
Figure 1.
Unadjusted estimates of overall cumulative mortality by CD4 cell count at start of antiretroviral therapy (ART).
Figure 2.
Figure 2.
Adjusted estimates of cumulative mortality by CD4 cell count at start of antiretroviral therapy (ART) for a typical patient group (men who have sex with men, aged 30–39 years, who started ART between 1998 and 1999 without a diagnosis of AIDS, with high viral load [human immunodeficiency virus {HIV}-1 RNA > 100 000 copies/µL]) from the French Hospital Database on HIV cohort.
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