Long-term mortality in HIV-positive individuals virally suppressed for >3 years with incomplete CD4 recovery

Some human immunodeficiency virus (HIV)-infected individuals initiating combination antiretroviral therapy (cART) with low CD4 counts achieve viral suppression but not CD4 cell recovery. We aimed to identify (1) risk factors for failure to achieve CD4 count >200 cells/µL after 3 years of sustaine...

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Bibliographic Details
Published in:Clinical infectious diseases Vol. 58; no. 9; p. 1312
Main Authors: Engsig, Frederik N, Zangerle, Robert, Katsarou, Olga, Dabis, Francois, Reiss, Peter, Gill, John, Porter, Kholoud, Sabin, Caroline, Riordan, Andrew, Fätkenheuer, Gerd, Gutiérrez, Félix, Raffi, Francois, Kirk, Ole, Mary-Krause, Murielle, Stephan, Christoph, de Olalla, Patricia Garcia, Guest, Jodie, Samji, Hasina, Castagna, Antonella, d'Arminio Monforte, Antonella, Skaletz-Rorowski, Adriane, Ramos, Jose, Lapadula, Giuseppe, Mussini, Cristina, Force, Lluís, Meyer, Laurence, Lampe, Fiona, Boufassa, Faroudy, Bucher, Heiner C, De Wit, Stéphane, Burkholder, Greer A, Teira, Ramon, Justice, Amy C, Sterling, Tim R, M Crane, Heidi, Gerstoft, Jan, Grarup, Jesper, May, Margaret, Chêne, Geneviève, Ingle, Suzanne M, Sterne, Jonathan, Obel, Niels
Format: Journal Article
Language:English
Published: United States 01.05.2014
Subjects:
Adult
Anti-HIV Agents - therapeutic use
Cause of Death
CD4 Lymphocyte Count
Cohort Studies
Female
Heterosexuality
HIV Infections - drug therapy
HIV Infections - mortality
HIV Infections - transmission
Humans
Logistic Models
Male
Middle Aged
Risk Factors
Substance-Related Disorders - complications
Viral Load
mortality
CD4 cell recovery
risk factors
sustained viral suppression
HIV
ISSN:1537-6591, 1537-6591
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Summary:Some human immunodeficiency virus (HIV)-infected individuals initiating combination antiretroviral therapy (cART) with low CD4 counts achieve viral suppression but not CD4 cell recovery. We aimed to identify (1) risk factors for failure to achieve CD4 count >200 cells/µL after 3 years of sustained viral suppression and (2) the association of the achieved CD4 count with subsequent mortality. We included treated HIV-infected adults from 2 large international HIV cohorts, who had viral suppression (≤500 HIV type 1 RNA copies/mL) for >3 years with CD4 count ≤200 cells/µL at start of the suppressed period. Logistic regression was used to identify risk factors for incomplete CD4 recovery (≤200 cells/µL) and Cox regression to identify associations with mortality. Of 5550 eligible individuals, 835 (15%) did not reach a CD4 count >200 cells/µL after 3 years of suppression. Increasing age, lower initial CD4 count, male heterosexual and injection drug use transmission, cART initiation after 1998, and longer time from initiation of cART to start of the virally suppressed period were risk factors for not achieving a CD4 count >200 cells/µL. Individuals with CD4 ≤200 cells/µL after 3 years of viral suppression had substantially increased mortality (adjusted hazard ratio, 2.60; 95% confidence interval, 1.86-3.61) compared with those who achieved CD4 count >200 cells/µL. The increased mortality was seen across different patient groups and for all causes of death. Virally suppressed HIV-positive individuals on cART who do not achieve a CD4 count >200 cells/µL have substantially increased long-term mortality.
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ISSN:1537-6591
1537-6591
DOI:10.1093/cid/ciu038