Long-term Mortality in HIV-Positive Individuals Virally Suppressed for > 3 Years With Incomplete CD4 Recovery
Por:
Engsig, FN, Zangerle, R, Katsarou, O, Dabis, F, Reiss, P, Gill, J, Porter, K, Sabin, C, Riordan, A, Fatkenheuer, G, Gutierrez, F, Raffi, F, Kirk, O, Mary-Krause, M, Stephan, C, de Olalla, PG, Guest, J, Samji, H, Castagna, A, Monforte, AD, Skaletz-Rorowski, A, Ramos, J, Lapadula, G, Mussini, C, Force, L, Meyer, L, Lampe, F, Boufassa, F, Bucher, HC, De Wit, S, Burkholder, GA, Teira, R, Justice, AC, Sterling, TR, Crane, HM, Gerstoft, J, Grarup, J, May, M, Chene, G, Ingle, SM, Sterne, J, Obel, N
Publicada:
1 may 2014
Resumen:
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/mu L 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/mu L at start of the suppressed period. Logistic regression was used to identify risk factors for incomplete CD4 recovery (<= 200 cells/mu L) and Cox regression to identify associations with mortality.
Results. Of 5550 eligible individuals, 835 (15%) did not reach a CD4 count >200 cells/mu L 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/mu L. Individuals with CD4 <= 200 cells/mu L 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/mu L. 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/mu L have substantially increased long-term mortality.
Filiaciones:
Engsig, FN:
Copenhagen Univ Hosp, Rigshosp, Dept Infect Dis, Copenhagen, Denmark
Statens Serum Inst, Dept Microbiol Diagnost & Virol, DK-2300 Copenhagen, Denmark
Zangerle, R:
Med Univ Innsbruck, Dept Dermatol & Venerol, A-6020 Innsbruck, Austria
Katsarou, O:
Laikon Gen Hosp, Ctr Blood, Athens, Greece
Laikon Gen Hosp, Natl Reference Ctr Congenital Bleeding Disorders, Athens, Greece
Dabis, F:
Univ Bordeaux, ISPED, Ctr INSERM Epidemiol Biostat U897, Bordeaux, France
Reiss, P:
Univ Amsterdam, Acad Med Ctr, NL-1105 AZ Amsterdam, Netherlands
Stichting HIV Monitoring, Amsterdam, Netherlands
Gill, J:
Univ Calgary, Dept Med, Calgary, AB T2N 1N4, Canada
Porter, K:
MRC Clin Trials Unit, London, England
Sabin, C:
UCL, Res Dept Infect & Populat Hlth, London WC1E 6BT, England
Riordan, A:
Alder Hey Childrens NHS Fdn Trust, Dept Paediat Infect Dis & Immunol, Liverpool, Merseyside, England
Fatkenheuer, G:
Univ Cologne, Dept Internal Med 1, Cologne, Germany
Gutierrez, F:
Univ Miguel Hernandez, Hosp Gen Univ Elche, Infect Dis Unit, Alicante, Spain
Raffi, F:
Hotel Dieu Univ Hosp, Dept Infect Dis, Nantes, France
Hotel Dieu Univ Hosp, HIV Clin Res Unit, Nantes, France
Kirk, O:
Copenhagen Univ Hosp, Rigshosp, Dept Infect Dis, Copenhagen, Denmark
Univ Copenhagen, Panum Inst, Copenhagen HIV Programme, DK-2100 Copenhagen O, Denmark
Mary-Krause, M:
Univ Paris 06, INSERM, Unite Mixte Rech Sante 943, Hop La Pitie Salpetriere, Paris, France
Stephan, C:
Goethe Univ Hosp, Dept Infect Dis, Frankfurt, Germany
de Olalla, PG:
Publ Hlth Agcy Barcelona, Epidemiol Serv, Barcelona, Spain
Guest, J:
Atlanta Vet Affairs Med Ctr, Atlanta, GA USA
Samji, H:
British Columbia Ctr Excellence HIV AIDS, Vancouver, BC, Canada
Castagna, A:
Ist Sci San Raffaele, Dept Infect & Trop Dis, I-20132 Milan, Italy
Monforte, AD:
San Paolo Univ Hosp, Dept Hlth Sci, Infect Dis Unit, Milan, Italy
Skaletz-Rorowski, A:
Ruhr Univ Bochum, Competence Network HIV AIDS, Bochum, Germany
Ramos, J:
Hosp Univ Getafe, Dept Pediat, Madrid, Spain
Lapadula, G:
Univ Milano Bicocca, San Gerardo Hosp, Dept Internal Med, Div Infect Dis, Monza, Italy
Mussini, C:
Med Specialties Univ Modena & Reggio Emilia, Dept Internal Med, Clin Infect Dis, Modena, Italy
Force, L:
Hosp de Mataro, Infect Dis Unit, Barcelona, Spain
Meyer, L:
Hop Bicetre, AP HP, Serv Epidemiol & Sante Publ, Paris, France
INSERM, U1018, F-75654 Paris 13, France
Univ Paris 11, Paris, France
Lampe, F:
UCL, Res Dept Infect & Populat Hlth, London WC1E 6BT, England
Boufassa, F:
Univ Paris 11, INSERM, CESP Ctr Res Epidemiol & Populat Hlth, Epidemiol HIV & STI Team, Le Kremlin Bicetre, France
Bucher, HC:
Univ Basel Hosp, Basel Inst Clin Epidemiol & Biostat, Basel, Switzerland
De Wit, S:
St Pierre Univ Hosp, Dept Infect Dis, Brussels, Belgium
Burkholder, GA:
Univ Alabama Birmingham, Div Infect Dis, Birmingham, AL USA
Teira, R:
Hosp Sierrallana Torrelavega, Med Interna Serv, Cantabria, Spain
Justice, AC:
Veterans Affairs Connecticut Healthcare Syst, West Haven, CT USA
Yale Univ, Sch Med, Dept Internal Med, New Haven, CT 06510 USA
Sterling, TR:
Vanderbilt Univ, Sch Med, Div Infect Dis, Nashville, TN 37212 USA
Crane, HM:
Univ Washington, Ctr AIDS Res, Clin Epidemiol & Hlth Serv Res Core, Seattle, WA 98195 USA
Gerstoft, J:
Copenhagen Univ Hosp, Rigshosp, Dept Infect Dis, Copenhagen, Denmark
Grarup, J:
Univ Copenhagen, Panum Inst, Copenhagen HIV Programme, DK-2100 Copenhagen O, Denmark
May, M:
Univ Bristol, Sch Social & Community Med, Bristol BS8 1TH, Avon, England
Chene, G:
Univ Bordeaux, ISPED, Ctr INSERM Epidemiol Biostat U897, Bordeaux, France
Ingle, SM:
Univ Bristol, Sch Social & Community Med, Bristol BS8 1TH, Avon, England
Sterne, J:
Univ Bristol, Sch Social & Community Med, Bristol BS8 1TH, Avon, England
Obel, N:
Copenhagen Univ Hosp, Rigshosp, Dept Infect Dis, Copenhagen, Denmark
Bronze, Green Published
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