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oai:repisalud.isciii.es:20.500.12105/141122025-05-08T18:04:26Zcom_20.500.12105_2052com_20.500.12105_2051com_20.500.12105_15322col_20.500.12105_19608col_20.500.12105_16961

00925njm 22002777a 4500 dc May, Margaret T author Vehreschild, Jörg-Janne author Trickey, Adam author Obel, Niels author Reiss, Peter author Bonnet, Fabrice author Mary-Krause, Murielle author Samji, Hasina author Cavassini, Matthias author Gill, Michael John author Shepherd, Leah C author Crane, Heidi M author d'Arminio Monforte, Antonella author Burkholder, Greer A author Johnson, Margaret M author Sobrino-Vegas, Paz author Domingo, Pere author Zangerle, Robert author Justice, Amy C author Sterling, Timothy R author Miró, José María author Sterne, Jonathan A C author Antiretroviral Therapy Cohort Collaboration (ART-CC) author 2016-06-15 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. Clin Infect Dis. 2016;62(12):1571-1577 10.1093/cid/ciw183 1537-6591 Clinical Infectious Diseases: an official publication of the Infectious Diseases Society of America 27025828 http://hdl.handle.net/20.500.12105/14112 CD4 count HIV Antiretroviral therapy Cohort collaboration Mortality 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