May, Margaret T., Vehreschild, Jorg-Janne, Trickey, Adam ORCID: 0000-0003-3462-2898, Obel, Niels, Reiss, Peter, Bonnet, Fabrice, Mary-Krause, Murielle, Samji, Hasina ORCID: 0000-0002-4555-7609, Cavassini, Matthias, Gill, Michael John ORCID: 0000-0002-8546-8790, Shepherd, Leah C., Crane, Heidi M., Monforte, Antonella d'Arminio, Burkholder, Greer A., Johnson, Margaret M., Sobrino-Vegas, Paz, Domingo, Pere, Zangerle, Robert, Justice, Amy C., Sterling, Timothy R., Miro, Jose M. and Sterne, Jonathan A. C. (2016). Mortality According to CD4 Count at Start of Combination Antiretroviral Therapy Among HIV-infected Patients Followed for up to 15 Years After Start of Treatment: Collaborative Cohort Study. Clin. Infect. Dis., 62 (12). S. 1571 - 1578. CARY: OXFORD UNIV PRESS INC. ISSN 1537-6591

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Abstract

Background. CD4 count at start of combination antiretroviral therapy (ART) is strongly associated with short-term survival, but its association with longer-term survival is less well characterized. Methods. We estimated mortality rates (MRs) by time since start of ART (<0.5, 0.5-0.9, 1-2.9, 3-4.9, 5-9.9, and >= 10 years) among patients from 18 European and North American cohorts who started ART during 1996-2001. Piecewise exponential models stratified by cohort were used to estimate crude and adjusted (for sex, age, transmission risk, period of starting ART [1996-1997, 1998-1999, 2000-2001], and AIDS and human immunodeficiency virus type 1 RNA at baseline) mortality rate ratios (MRRs) by CD4 count at start of ART (0-49, 50-99, 100-199, 200-349, 350-499, >= 500 cells/mu L) overall and separately according to time since start of ART. Results. A total of 6344 of 37 496 patients died during 359 219 years of follow-up. The MR per 1000 person-years was 32.8 (95% confidence interval [CI], 30.2-35.5) during the first 6 months, declining to 16.0 (95% CI, 15.4-16.8) during 5-9.9 years and 14.2 (95% CI, 13.3-15.1) after 10 years' duration of ART. During the first year of ART, there was a strong inverse association of CD4 count at start of ART with mortality. This diminished over the next 4 years. The adjusted MRR per CD4 group was 0.97 (95% CI, .94-1.00; P = .054) and 1.02 (95% CI, .98-1.07; P = .32) among patients followed for 5-9.9 and >= 10 years, respectively. Conclusions. After surviving 5 years of ART, the mortality of patients who started ART with low baseline CD4 count converged with mortality of patients with intermediate and high baseline CD4 counts.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
May, Margaret T.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Vehreschild, Jorg-JanneUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Trickey, AdamUNSPECIFIEDorcid.org/0000-0003-3462-2898UNSPECIFIED
Obel, NielsUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Reiss, PeterUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Bonnet, FabriceUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Mary-Krause, MurielleUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Samji, HasinaUNSPECIFIEDorcid.org/0000-0002-4555-7609UNSPECIFIED
Cavassini, MatthiasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Gill, Michael JohnUNSPECIFIEDorcid.org/0000-0002-8546-8790UNSPECIFIED
Shepherd, Leah C.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Crane, Heidi M.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Monforte, Antonella d'ArminioUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Burkholder, Greer A.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Johnson, Margaret M.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Sobrino-Vegas, PazUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Domingo, PereUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Zangerle, RobertUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Justice, Amy C.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Sterling, Timothy R.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Miro, Jose M.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Sterne, Jonathan A. C.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-272228
DOI: 10.1093/cid/ciw183
Journal or Publication Title: Clin. Infect. Dis.
Volume: 62
Number: 12
Page Range: S. 1571 - 1578
Date: 2016
Publisher: OXFORD UNIV PRESS INC
Place of Publication: CARY
ISSN: 1537-6591
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
T-CELL RECOVERY; HIV-1-INFECTED PATIENTS; SURVIVAL; INITIATION; PROGNOSIS; INTENSIFICATION; MARAVIROC; PREDICT; CART; RISKMultiple languages
Immunology; Infectious Diseases; MicrobiologyMultiple languages
Refereed: Yes
URI: http://kups.ub.uni-koeln.de/id/eprint/27222

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