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)
1
2nd Blood Transfusion Center and Hemophilia Center
2 Epidémiologie et Biostatistique [Bordeaux]
3 SPRAM - UMR 5819 - Structures et propriétés d'architectures moléculaire
4 OMNT - UMS 2920 - Observatoire des Micro et Nano Technologies
5 Southern Alberta Clinic
6 Research Department of Infection and Population Health [London]
7 Equipe Perception et design sonores
8 Equipe Interactions musicales temps-réel
9 Maladies infectieuses et tropicales
10 UPMC - Université Pierre et Marie Curie - Paris 6
11 Institute of Biology, Neuchatel
12 School of Psychology and Neuroscience [University of St. Andrews]
13 Infectious Diseases
14 EA 4100
15 Laboratory of Inorganic Chemistry
16 Princeton University
17 IRM - Immuno-Rhumatologie Moléculaire
18 Population Sciences
19 CESP - Centre de recherche en épidémiologie et santé des populations
20 Paläontologisches Institut und Museum
21 Laboratory
22 Rigshospitalet [Copenhagen]
23 Department of Social Medicine
24 Department of Infectious Diseases
2 Epidémiologie et Biostatistique [Bordeaux]
3 SPRAM - UMR 5819 - Structures et propriétés d'architectures moléculaire
4 OMNT - UMS 2920 - Observatoire des Micro et Nano Technologies
5 Southern Alberta Clinic
6 Research Department of Infection and Population Health [London]
7 Equipe Perception et design sonores
8 Equipe Interactions musicales temps-réel
9 Maladies infectieuses et tropicales
10 UPMC - Université Pierre et Marie Curie - Paris 6
11 Institute of Biology, Neuchatel
12 School of Psychology and Neuroscience [University of St. Andrews]
13 Infectious Diseases
14 EA 4100
15 Laboratory of Inorganic Chemistry
16 Princeton University
17 IRM - Immuno-Rhumatologie Moléculaire
18 Population Sciences
19 CESP - Centre de recherche en épidémiologie et santé des populations
20 Paläontologisches Institut und Museum
21 Laboratory
22 Rigshospitalet [Copenhagen]
23 Department of Social Medicine
24 Department of Infectious Diseases
Frederik N Engsig
- Fonction : Auteur
Robert Zangerle
- Fonction : Auteur
Kholoud Porter
- Fonction : Auteur
Andrew Riordan
- Fonction : Auteur
Gerd Fätkenheuer
- Fonction : Auteur
Ole Kirk
- Fonction : Auteur
Patricia Garcia de Olalla
- Fonction : Auteur
Jodie Guest
- Fonction : Auteur
Hasina Samji
- Fonction : Auteur
Antonella d'Arminio Monforte
- Fonction : Auteur
Adriane Skaletz-Rorowski
- Fonction : Auteur
Lluís Force
- Fonction : Auteur
Laurence Meyer
- Fonction : Auteur
- PersonId : 756223
- ORCID : 0000-0001-5707-2062
- IdRef : 077686659
Faroudy Boufassa
- Fonction : Auteur
- PersonId : 756224
- ORCID : 0000-0002-3650-6105
Greer A Burkholder
- Fonction : Auteur
Ramon Teira
- Fonction : Auteur
Amy C Justice
- Fonction : Auteur
Tim R Sterling
- Fonction : Auteur
Heidi M Crane
- Fonction : Auteur
Jesper Grarup
- Fonction : Auteur
Suzanne M Ingle
- Fonction : Auteur
Jonathan Sterne
- Fonction : Auteur
Résumé
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.