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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Long-term mortality in HIV-positive individuals virally suppressed for >3 years with incomplete CD4 recovery
Clinical Infectious Diseases, Volume 58, No. 9, Year 2014
Notification
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Description
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. © The Author 2014.
Authors & Co-Authors
Zangerle, Robert
Austria, Innsbruck
Medizinische Universitat Innsbruck
Katsarou, Olga I.
Greece, Athens
Laikon General Hospital
Dabis, Franćois Ç.Ois
France, Paris
Inserm
Reiss, Peter
Netherlands, Amsterdam
Amsterdam Umc - University of Amsterdam
Netherlands, Amsterdam
Stichting Hiv Monitoring
Gill, M. John
Canada, Calgary
University of Calgary
Porter, Kholoud
United Kingdom, London
Mrc Clinical Trials Unit
Sabin, Caroline Anne
United Kingdom, London
University College London
Riordan, Andrew F.
United Kingdom, Liverpool
Alder Hey Children's Nhs Foundation Trust
Fätkenheuer, Gerd
Germany, Koln
Universität zu Köln
Gutieŕrez, Félix
Spain, Elche
Universidad Miguel Hernández de Elche
Raffi, François
France, Nantes
Hôtel Dieu Chu de Nantes
Kirk, Ole
Denmark, Copenhagen
Rigshospitalet
Denmark, Copenhagen
Københavns Universitet
Mary-Krause, Murielle
France, Paris
Sorbonne Université
Stephan, Christoph J.
Germany, Frankfurt am Main
Universitätsklinikum Frankfurt
García-De-Olalla, Patrícia
Spain, Barcelona
Agencia de Salut Publica de Barcelona
Guest, Jodie Lynn
Unknown Affiliation
Samji, Hasina
Canada, Vancouver
British Columbia Centre for Excellence in Hiv-aids
Castagna, Antonella
Italy, Milan
Irccs Ospedale San Raffaele
D'Arminio Monforte, Antonella D.
Italy, Milan
Ospedale San Paolo
Skaletz-Rorowski, Adriane
Germany, Bochum
Ruhr-universitat Bochum
Ramos-Rincón, José Manuel
Spain, Getafe
Hospital Universitario de Getafe
Lapadula, Giuseppe
Italy, Monza
Azienda Ospedaliera San Gerardo Monza
Mussini, Cristina
Italy, Modena
Università Degli Studi Di Modena e Reggio Emilia, Facoltà Di Medicina e Chirurgia
Meyer, Laurence J.
France, Gif-sur-yvette
Université Paris-saclay
Lampe, Fiona C.
United Kingdom, London
University College London
Boufassa, Faroudy
France, Gif-sur-yvette
Université Paris-saclay
Bucher, Heíner C.C.
Switzerland, Basel
Universitätsspital Basel
de Wit, Stéphane A.
Belgium, Brussels
Centre Hospitalier Universitaire Saint Pierre, Brussels
Burkholder, Greer A.
United States, Birmingham
The University of Alabama at Birmingham
Teira, Ramón M.
Unknown Affiliation
Justice, Amy C.
United States, West Haven
Va Connecticut Healthcare System
United States, New Haven
Yale School of Medicine
Sterling, Timothy R.
United States, Nashville
Vanderbilt University
Crane, Heidi M.
United States, Seattle
University of Washington
Gerstoft, Jan
Denmark, Copenhagen
Rigshospitalet
Grarup, Jesper
Denmark, Copenhagen
Københavns Universitet
May, Margaret T.
United Kingdom, Bristol
University of Bristol
Chêne, Geneviève
France, Paris
Inserm
Ingle, Suzanne M.
United Kingdom, Bristol
University of Bristol
Sterne, Jonathan A.C.
United Kingdom, Bristol
University of Bristol
Obel, Niels
Denmark, Copenhagen
Rigshospitalet
Statistics
Citations: 133
Authors: 40
Affiliations: 35
Identifiers
Doi:
10.1093/cid/ciu038
ISSN:
10584838
Research Areas
Environmental
Health System And Policy
Infectious Diseases
Study Design
Cohort Study
Participants Gender
Male