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

Type of publication Peer-reviewed
Publikationsform Original article (peer-reviewed)
Author 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,
Project Swiss HIV Cohort Study (SHCS)
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Original article (peer-reviewed)

Journal Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
Volume (Issue) 58(9)
Page(s) 1312 - 21
Title of proceedings Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
DOI 10.1093/cid/ciu038

Open Access

URL http://doc.rero.ch/record/290486
Type of Open Access Repository (Green Open Access)

Abstract

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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