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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Vydáno v:BMC infectious diseases Ročník 10; číslo 1; s. 318
Hlavní autoři: Engsig, Frederik N, Gerstoft, Jan, Kronborg, Gitte, Larsen, Carsten S, Pedersen, Gitte, Røge, Birgit, Jensen, Janne, Nielsen, Lars N, Obel, Niels
Médium: Journal Article
Jazyk:angličtina
Vydáno: London BioMed Central 02.11.2010
BioMed Central Ltd
Springer Nature B.V
BMC
Témata:
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
Denmark
Viral Load Test
Injection Drug User
Immunological Suppression
Viral Load Suppression
Viral Load
ISSN:1471-2334, 1471-2334
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Shrnutí: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.
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ISSN:1471-2334
1471-2334
DOI:10.1186/1471-2334-10-318