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

Frederik N Engsig Robert Zangerle Olga Katsarou 1 Francois Dabis 2 Peter Reiss 3, 4 John Gill 5 Kholoud Porter Caroline Sabin 6 Andrew Riordan Gerd Fätkenheuer Félix Gutiérrez 7, 8 Francois Raffi 9 Ole Kirk Murielle Mary-Krause 10 Christoph Stephan 11, 12 Patricia Garcia de Olalla Jodie Guest Hasina Samji Antonella Castagna 13 Antonella d'Arminio Monforte Adriane Skaletz-Rorowski Jose Ramos 14 Giuseppe Lapadula 15 Cristina Mussini 16 Lluís Force Laurence Meyer 17 Fiona Lampe 18 Faroudy Boufassa 19 Heiner C Bucher 20 Stéphane de Wit 21 Greer A Burkholder Ramon Teira Amy C Justice Tim R Sterling Heidi M Crane Jan Gerstoft 22 Jesper Grarup Margaret May 23 Geneviève Chêne 2 Suzanne M Ingle Jonathan Sterne Niels Obel 24 
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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Submitted on : Thursday, January 22, 2015 - 11:52:34 AM
Last modification on : Friday, April 29, 2022 - 10:13:02 AM


  • HAL Id : hal-01108170, version 1
  • PUBMED : 24457342


Frederik N Engsig, Robert Zangerle, Olga Katsarou, Francois Dabis, Peter Reiss, et al.. Long-term mortality in HIV-positive individuals virally suppressed for >3 years with incomplete CD4 recovery.. Clinical Infectious Diseases, Oxford University Press (OUP), 2014, 58 (9), pp.1312-21. ⟨hal-01108170⟩



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