Long-term mortality in HIV patients virally suppressed for more than three years with incomplete CD4 recovery: A cohort study

Background The mortality in patients with persistent low CD4 count despite several years of HAART with sustained viral suppression is poorly documented. We aimed to identify predictors for inadequate CD4 cell recovery and estimate mortality in patients with low CD4 count but otherwise successful HAA...

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Published in:BMC infectious diseases Vol. 10; no. 1; p. 318
Main Authors: Engsig, Frederik N, Gerstoft, Jan, Kronborg, Gitte, Larsen, Carsten S, Pedersen, Gitte, Røge, Birgit, Jensen, Janne, Nielsen, Lars N, Obel, Niels
Format: Journal Article
Language:English
Published: London BioMed Central 02.11.2010
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ISSN:1471-2334, 1471-2334
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Abstract Background The mortality in patients with persistent low CD4 count despite several years of HAART with sustained viral suppression is poorly documented. We aimed to identify predictors for inadequate CD4 cell recovery and estimate mortality in patients with low CD4 count but otherwise successful HAART. Method In a nationwide cohort of HIV patients we identified all individuals who started HAART before 1 January 2005 with CD4 cell count ≤ 200 cells/μL and experienced three years with sustained viral suppression. Patients were categorized according to CD4 cell count after the three years suppressed period (≤ 200 cells/μL; immunological non-responders (INRs), >200 cells/μL; immunological responders (IRs)). We used logistic regression and Kaplan-Meier analysis to estimated risk factors and mortality for INRs compared to IRs. Results We identified 55 INRs and 236 IRs. In adjusted analysis age > 40 years and > one year from first CD4 cell count ≤ 200 cells/μL to start of the virologically suppressed period were associated with increased risk of INR. INRs had substantially higher mortality compared to IRs. The excess mortality was mainly seen in the INR group with > one year of immunological suppression prior to viral suppression and injection drug users (IDUs). Conclusion Age and prolonged periods of immune deficiency prior to successful HAART are risk factors for incomplete CD4 cell recovery. INRs have substantially increased long-term mortality mainly associated with prolonged immunological suppression prior to viral suppression and IDU.
AbstractList The mortality in patients with persistent low CD4 count despite several years of HAART with sustained viral suppression is poorly documented. We aimed to identify predictors for inadequate CD4 cell recovery and estimate mortality in patients with low CD4 count but otherwise successful HAART.BACKGROUNDThe mortality in patients with persistent low CD4 count despite several years of HAART with sustained viral suppression is poorly documented. We aimed to identify predictors for inadequate CD4 cell recovery and estimate mortality in patients with low CD4 count but otherwise successful HAART.In a nationwide cohort of HIV patients we identified all individuals who started HAART before 1 January 2005 with CD4 cell count ≤ 200 cells/μL and experienced three years with sustained viral suppression. Patients were categorized according to CD4 cell count after the three years suppressed period (≤ 200 cells/μL; immunological non-responders (INRs), >200 cells/μL; immunological responders (IRs)). We used logistic regression and Kaplan-Meier analysis to estimated risk factors and mortality for INRs compared to IRs.METHODIn a nationwide cohort of HIV patients we identified all individuals who started HAART before 1 January 2005 with CD4 cell count ≤ 200 cells/μL and experienced three years with sustained viral suppression. Patients were categorized according to CD4 cell count after the three years suppressed period (≤ 200 cells/μL; immunological non-responders (INRs), >200 cells/μL; immunological responders (IRs)). We used logistic regression and Kaplan-Meier analysis to estimated risk factors and mortality for INRs compared to IRs.We identified 55 INRs and 236 IRs. In adjusted analysis age > 40 years and > one year from first CD4 cell count ≤ 200 cells/μL to start of the virologically suppressed period were associated with increased risk of INR. INRs had substantially higher mortality compared to IRs. The excess mortality was mainly seen in the INR group with > one year of immunological suppression prior to viral suppression and injection drug users (IDUs).RESULTSWe identified 55 INRs and 236 IRs. In adjusted analysis age > 40 years and > one year from first CD4 cell count ≤ 200 cells/μL to start of the virologically suppressed period were associated with increased risk of INR. INRs had substantially higher mortality compared to IRs. The excess mortality was mainly seen in the INR group with > one year of immunological suppression prior to viral suppression and injection drug users (IDUs).Age and prolonged periods of immune deficiency prior to successful HAART are risk factors for incomplete CD4 cell recovery. INRs have substantially increased long-term mortality mainly associated with prolonged immunological suppression prior to viral suppression and IDU.CONCLUSIONAge and prolonged periods of immune deficiency prior to successful HAART are risk factors for incomplete CD4 cell recovery. INRs have substantially increased long-term mortality mainly associated with prolonged immunological suppression prior to viral suppression and IDU.
The mortality in patients with persistent low CD4 count despite several years of HAART with sustained viral suppression is poorly documented. We aimed to identify predictors for inadequate CD4 cell recovery and estimate mortality in patients with low CD4 count but otherwise successful HAART. In a nationwide cohort of HIV patients we identified all individuals who started HAART before 1 January 2005 with CD4 cell count [less than or equal to] 200 cells/[mu]L and experienced three years with sustained viral suppression. Patients were categorized according to CD4 cell count after the three years suppressed period ([less than or equal to] 200 cells/[mu]L; immunological non-responders (INRs), >200 cells/[mu]L; immunological responders (IRs)). We used logistic regression and Kaplan-Meier analysis to estimated risk factors and mortality for INRs compared to IRs. We identified 55 INRs and 236 IRs. In adjusted analysis age > 40 years and > one year from first CD4 cell count [less than or equal to] 200 cells/[mu]L to start of the virologically suppressed period were associated with increased risk of INR. INRs had substantially higher mortality compared to IRs. The excess mortality was mainly seen in the INR group with > one year of immunological suppression prior to viral suppression and injection drug users (IDUs). Age and prolonged periods of immune deficiency prior to successful HAART are risk factors for incomplete CD4 cell recovery. INRs have substantially increased long-term mortality mainly associated with prolonged immunological suppression prior to viral suppression and IDU.
Background The mortality in patients with persistent low CD4 count despite several years of HAART with sustained viral suppression is poorly documented. We aimed to identify predictors for inadequate CD4 cell recovery and estimate mortality in patients with low CD4 count but otherwise successful HAART. Method In a nationwide cohort of HIV patients we identified all individuals who started HAART before 1 January 2005 with CD4 cell count ≤ 200 cells/μL and experienced three years with sustained viral suppression. Patients were categorized according to CD4 cell count after the three years suppressed period (≤ 200 cells/μL; immunological non-responders (INRs), >200 cells/μL; immunological responders (IRs)). We used logistic regression and Kaplan-Meier analysis to estimated risk factors and mortality for INRs compared to IRs. Results We identified 55 INRs and 236 IRs. In adjusted analysis age > 40 years and > one year from first CD4 cell count ≤ 200 cells/μL to start of the virologically suppressed period were associated with increased risk of INR. INRs had substantially higher mortality compared to IRs. The excess mortality was mainly seen in the INR group with > one year of immunological suppression prior to viral suppression and injection drug users (IDUs). Conclusion Age and prolonged periods of immune deficiency prior to successful HAART are risk factors for incomplete CD4 cell recovery. INRs have substantially increased long-term mortality mainly associated with prolonged immunological suppression prior to viral suppression and IDU.
The mortality in patients with persistent low CD4 count despite several years of HAART with sustained viral suppression is poorly documented. We aimed to identify predictors for inadequate CD4 cell recovery and estimate mortality in patients with low CD4 count but otherwise successful HAART. In a nationwide cohort of HIV patients we identified all individuals who started HAART before 1 January 2005 with CD4 cell count ≤ 200 cells/μL and experienced three years with sustained viral suppression. Patients were categorized according to CD4 cell count after the three years suppressed period (≤ 200 cells/μL; immunological non-responders (INRs), >200 cells/μL; immunological responders (IRs)). We used logistic regression and Kaplan-Meier analysis to estimated risk factors and mortality for INRs compared to IRs. We identified 55 INRs and 236 IRs. In adjusted analysis age > 40 years and > one year from first CD4 cell count ≤ 200 cells/μL to start of the virologically suppressed period were associated with increased risk of INR. INRs had substantially higher mortality compared to IRs. The excess mortality was mainly seen in the INR group with > one year of immunological suppression prior to viral suppression and injection drug users (IDUs). Age and prolonged periods of immune deficiency prior to successful HAART are risk factors for incomplete CD4 cell recovery. INRs have substantially increased long-term mortality mainly associated with prolonged immunological suppression prior to viral suppression and IDU.
Abstract Background The mortality in patients with persistent low CD4 count despite several years of HAART with sustained viral suppression is poorly documented. We aimed to identify predictors for inadequate CD4 cell recovery and estimate mortality in patients with low CD4 count but otherwise successful HAART. Method In a nationwide cohort of HIV patients we identified all individuals who started HAART before 1 January 2005 with CD4 cell count ≤ 200 cells/μL and experienced three years with sustained viral suppression. Patients were categorized according to CD4 cell count after the three years suppressed period (≤ 200 cells/μL; immunological non-responders (INRs), >200 cells/μL; immunological responders (IRs)). We used logistic regression and Kaplan-Meier analysis to estimated risk factors and mortality for INRs compared to IRs. Results We identified 55 INRs and 236 IRs. In adjusted analysis age > 40 years and > one year from first CD4 cell count ≤ 200 cells/μL to start of the virologically suppressed period were associated with increased risk of INR. INRs had substantially higher mortality compared to IRs. The excess mortality was mainly seen in the INR group with > one year of immunological suppression prior to viral suppression and injection drug users (IDUs). Conclusion Age and prolonged periods of immune deficiency prior to successful HAART are risk factors for incomplete CD4 cell recovery. INRs have substantially increased long-term mortality mainly associated with prolonged immunological suppression prior to viral suppression and IDU.
Background The mortality in patients with persistent low CD4 count despite several years of HAART with sustained viral suppression is poorly documented. We aimed to identify predictors for inadequate CD4 cell recovery and estimate mortality in patients with low CD4 count but otherwise successful HAART. Method In a nationwide cohort of HIV patients we identified all individuals who started HAART before 1 January 2005 with CD4 cell count [less than or equal to] 200 cells/[mu]L and experienced three years with sustained viral suppression. Patients were categorized according to CD4 cell count after the three years suppressed period ([less than or equal to] 200 cells/[mu]L; immunological non-responders (INRs), >200 cells/[mu]L; immunological responders (IRs)). We used logistic regression and Kaplan-Meier analysis to estimated risk factors and mortality for INRs compared to IRs. Results We identified 55 INRs and 236 IRs. In adjusted analysis age > 40 years and > one year from first CD4 cell count [less than or equal to] 200 cells/[mu]L to start of the virologically suppressed period were associated with increased risk of INR. INRs had substantially higher mortality compared to IRs. The excess mortality was mainly seen in the INR group with > one year of immunological suppression prior to viral suppression and injection drug users (IDUs). Conclusion Age and prolonged periods of immune deficiency prior to successful HAART are risk factors for incomplete CD4 cell recovery. INRs have substantially increased long-term mortality mainly associated with prolonged immunological suppression prior to viral suppression and IDU.
ArticleNumber 318
Audience Academic
Author Larsen, Carsten S
Jensen, Janne
Røge, Birgit
Kronborg, Gitte
Nielsen, Lars N
Gerstoft, Jan
Pedersen, Gitte
Obel, Niels
Engsig, Frederik N
AuthorAffiliation 1 Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
6 Department of Infectious Diseases, Fredericia and Kolding Sygehus, Skovvangen 2-8, 6000 Kolding, Denmark
5 Department of Infectious Diseases, Odense University Hospital, Sønderbouldevard 65, 5000 Odense C, Denmark
7 Department of Infectious Diseases - Hillerød, Hillerød Sygehus, Dyrehavevej 29, Hillerød 3400, Denmark
4 Department of Infectious Diseases, Aalborg University Hospital, 9000 Aalborg, Denmark
2 Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre Hospital, Kettegårds Allé 30, 2650 Hvidovre, Denmark
3 Department of Infectious Diseases, Aarhus University Hospital, Skejby Sygehus, Brendstrupgårdsvej, DK8200 Aarhus N, Denmark
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  organization: Department of Infectious Diseases, Copenhagen University Hospital
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  surname: Gerstoft
  fullname: Gerstoft, Jan
  organization: Department of Infectious Diseases, Copenhagen University Hospital
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  givenname: Gitte
  surname: Kronborg
  fullname: Kronborg, Gitte
  organization: Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre Hospital
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  organization: Department of Infectious Diseases, Aarhus University Hospital
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  surname: Pedersen
  fullname: Pedersen, Gitte
  organization: Department of Infectious Diseases, Aalborg University Hospital
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  organization: Department of Infectious Diseases, Fredericia and Kolding Sygehus
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  givenname: Lars N
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  fullname: Nielsen, Lars N
  organization: Department of Infectious Diseases - Hillerød, Hillerød Sygehus
– sequence: 9
  givenname: Niels
  surname: Obel
  fullname: Obel, Niels
  organization: Department of Infectious Diseases, Copenhagen University Hospital
BackLink https://www.ncbi.nlm.nih.gov/pubmed/21044307$$D View this record in MEDLINE/PubMed
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ContentType Journal Article
Copyright Engsig et al; licensee BioMed Central Ltd. 2010
COPYRIGHT 2010 BioMed Central Ltd.
2010 Engsig et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright ©2010 Engsig et al; licensee BioMed Central Ltd. 2010 Engsig et al; licensee BioMed Central Ltd.
Copyright_xml – notice: Engsig et al; licensee BioMed Central Ltd. 2010
– notice: COPYRIGHT 2010 BioMed Central Ltd.
– notice: 2010 Engsig et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
– notice: Copyright ©2010 Engsig et al; licensee BioMed Central Ltd. 2010 Engsig et al; licensee BioMed Central Ltd.
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Issue 1
Keywords Viral Load Test
Injection Drug User
Immunological Suppression
Viral Load Suppression
Viral Load
Language English
License http://creativecommons.org/licenses/by/2.0
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Snippet Background The mortality in patients with persistent low CD4 count despite several years of HAART with sustained viral suppression is poorly documented. We...
The mortality in patients with persistent low CD4 count despite several years of HAART with sustained viral suppression is poorly documented. We aimed to...
Background The mortality in patients with persistent low CD4 count despite several years of HAART with sustained viral suppression is poorly documented. We...
Abstract Background: The mortality in patients with persistent low CD4 count despite several years of HAART with sustained viral suppression is poorly...
Abstract Background The mortality in patients with persistent low CD4 count despite several years of HAART with sustained viral suppression is poorly...
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StartPage 318
SubjectTerms Acquired immune deficiency syndrome
Adult
Age Factors
AIDS
Anti-HIV Agents - administration & dosage
Antiretroviral Therapy, Highly Active
Blood - virology
Cancer
Care and treatment
CD4 Lymphocyte Count
Cohort Studies
Demographic aspects
Denmark
Female
Highly active antiretroviral therapy
HIV
HIV infection
HIV Infections - drug therapy
HIV Infections - immunology
HIV Infections - mortality
Human immunodeficiency virus
Humans
Immune Tolerance
Immunosuppression
Infectious Diseases
Internal Medicine
Male
Medical Microbiology
Medical research
Medicine
Medicine & Public Health
Middle Aged
Mortality
Parasitology
Patient outcomes
Research Article
Risk Factors
Survival Analysis
Time Factors
Tropical Medicine
Viral Load
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Title Long-term mortality in HIV patients virally suppressed for more than three years with incomplete CD4 recovery: A cohort study
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