Please use this identifier to cite or link to this item:http://hdl.handle.net/20.500.12105/14112
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 ISCIII | Domingo, Pere | Zangerle, Robert | Justice, Amy C | Sterling, Timothy R | Miró, José M | Sterne, Jonathan A C | Antiretroviral Therapy Cohort Collaboration (ART-CC)
Clin Infect Dis. 2016;62(12):1571-1577
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.
CD4 Lymphocyte Count | Adolescent | Adult | Anti-Retroviral Agents | Cohort Studies | Female | HIV Infections | Humans | Kaplan-Meier Estimate | Male | Middle Aged | Young Adult