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Long-term Mortality in HIV-Positive Individuals Virally Suppressed for >3 Years With Incomplete CD4 Recovery

2014; Oxford University Press; Volume: 58; Issue: 9 Linguagem: Inglês

10.1093/cid/ciu038

1537-6591

Frederik Neess Engsig, Robert Zangerle, Όλγα Κατσαρού, François Dabis, Peter Reiss, M. John Gill, Kholoud Porter, Caroline Sabin, Andrew Riordan, Gerd Fätkenheuer, Félix Gutiérrez, François Raffi, Ole Kirk, Murielle Mary‐Krause, Christoph Stephan, Felipe García, Jodie L. Guest, Hasina Samji, Antonella Castagna, Antonella d’Arminio Monforte, Adriane Skaletz‐Rorowski, José Manuel Ramos, Giuseppe Lapadula, Cristina Mussini, Lluís Force, Laurence Meyer, Fiona Lampe, Faroudy Boufassa, Heiner C. Bucher, Christoph Stephan, Greer A. Burkholder, Ramón Teira, Amy C. Justice, Tim Sterling, Heidi M. Crane, Jan Gerstoft, Jesper Grarup, Margaret May, Geneviève Chêne, Suzanne M Ingle, Jonathan A C Sterne, Niels Obel, Frederik Neess Engsig, Robert Zangerle, Όλγα Κατσαρού, François Dabis, Peter Reiss, M. John Gill, Kholoud Porter, Caroline Sabin, Andrew Riordan, Gerd Fätkenheuer, Félix Gutiérrez, François Raffi, Ole Kirk, Murielle Mary‐Krause, Christoph Stephan, Felipe García, Jodie L. Guest, Hasina Samji, Antonella Castagna, Antonella d’Arminio Monforte, Adriane Skaletz‐Rorowski, José Manuel Ramos, Giuseppe Lapadula, Cristina Mussini, Lluís Force, Laurence Meyer, Fiona Lampe, Faroudy Boufassa, Heiner C. Bucher, Christoph Stephan, Greer A. Burkholder, Ramón Teira, Amy C. Justice, Tim Sterling, Heidi M. Crane, Jan Gerstoft, Jesper Grarup, Margaret May, Geneviève Chêne, Suzanne M Ingle, Jonathan A C Sterne, Andrew Boulle, Hans‐Reinhard Brodt, Jordi Casabona, Matthias Cavassini, Geneviève Chêne, Dominique Costagliola, François Dabis, Antonella d’Arminio Monforte, Julia del Amo, Ard van Sighem, Gerd Fätkenheuer, M. John Gill, Jodie L. Guest, David Hans-Ulrich Haerry, Robert S. Hogg, Amy C. Justice, Amanda Mocroft, Niels Obel, Mari M. Kitahata, Fiona Lampe, Peter Reiss, Michael S. Saag, Tim Sterling, Ramón Teira, Matthew Williams, Robert Zangerle, Suzanne M Ingle, Margaret May, Jonathan A C Sterne, Robert Zangerle, Giota Touloumi, Josiane Warszawski, Laurence Meyer, François Dabis, Murielle Mary Krause, Jade Ghosn, Catherine Leport, Peter Reiss, Ferdinand Wit, Maria Prins, Heiner C. Bucher, Caroline Sabin, Diana M. Gibb, Gerd Fätkenheuer, Julia del Amo, Niels Obel, Claire Thorne, Amanda Mocroft, Ole Kirk, Christoph Stephan, Santiago Pérez‐Hoyos, Osamah Hamouda, Barbara Gussenheimer-Bartmeyer, Antoni Noguera‐Julián, Andrea Antinori, Antonella d’Arminio Monforte, Norbert H. Brockmeyer, José Manuel Ramos, Manuel Battegay, Andri Rauch, Cristina Mussini, P Tookey, Jordi Casabona, José M. Miró, Antonella Castagna, Christoph Stephan, Tessa Goetghebuer, Carlo Torti, Ramón Teira, Myriam Garrido, Ali Judd, Pablo Rojo, David Haerry, Ian Weller, Jordi Casabona, Dominique Costagliola, Antonella d’Arminio Monforte, Manuel Battegay, Christoph Stephan, Julia del Amo, Jesper Grarup, Geneviève Chêne, Céline Colin, Christine Schwimmer, Monique Termote, Jesper Kjær, Maria Campbell, Dorthe Raben, Manuel Battegay, Julia Bohlius, Vincent Bouteloup, Heiner C. Bucher, Alessandro Cozzi‐Lepri, François Dabis, Antonella d’Arminio Monforte, Julia del Amo, Maria Dorrucci, Matthias Egger, Frederik Neess Engsig, Hansjakob Furrer, Ali Judd, Ole Kirk, Olivier Lambotte, Charlotte Lewden, Sara Lodi, Rebbeca Lodwick, Sophie Matheron, Laurence Meyer, José M. Miró, Amanda Mocroft, Susana Monge, Fumiyo Nakagawa, Niels Obel, Roger Paredes, Andrew Phillips, Massimo Puoti, Joanne Reekie, Caroline Sabin, Alexandra Scherrer, Colette Smit, Jonathan A C Sterne, Rodolphe Thiébaut, Claire Thorne, Carlo Torti, Giota Touloumi, Linda Wittkop,

HIV Research and Treatment

Background. 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. Methods. 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. Results. 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. Conclusions. Virally suppressed HIV-positive individuals on cART who do not achieve a CD4 count >200 cells/µL have substantially increased long-term mortality.