All-cause mortality in treated HIV-infected adults with CD4 ≥500/mm3 compared with the general population: evidence from a large European observational cohort collaboration
Collaboration of Observational HIV Epidemiological Research Europe (COHERE) in EuroCoord, Charlotte Lewden, Vincent Bouteloup, Stéphane De Wit, Caroline Sabin, Amanda Mocroft, Jan Christian Wasmuth, Ard van Sighem, Ole Kirk, Niels Obel, George Panos, Jade Ghosn, François Dabis, Murielle Mary-Krause, Catherine Leport, Santiago Perez-Hoyos, Paz Sobrino-Vegas, Christoph Stephan, Antonella Castagna, Andrea Antinori, Antonella d'Arminio Monforte, Carlo Torti, Cristina Mussini, Virginia Isern, Alexandra Calmy, Ramón Teira, Matthias Egger, Jesper Grarup, Geneviève Chêne, Charlotte Lewden, Vincent Bouteloup, Giota Touloumi, Jade Ghosn, François Dabis, Murielle Mary-Krause, Catherine Leport, François Raffi, Ard van Sighem, Santiago Perez-Hoyos, Caroline Sabin, Jan Christian Wasmuth, Paz Sobrino, Santiago Perez-Cachafeiro, Niels Obel, Amanda Mocroft, Ole Kirk, Schlomo Staszewski, Christoph Stephan, Antonella Castagna, Antonella d'Arminio Monforte, Annalisa Ridolfo, Carlo Torti, Cristina Mussini, Virginia Isern, Alexandra Calmy, Stéphane De Wit, Ramón Teira, Matthias Egger, Geneviève Chêne, Robert Zangerle, Giota Touloumi, Josiane Warszawski, Laurence Meyer, François Dabis, Murielle Mary- Krause, Jade Ghosn, Catherine Leport, Frank de Wolf, Peter Reiss, Maria Prins, Heiner Bucher, Caroline Sabin, Diana Gibb, Gerd Fätkenheuer, Julia Del Amo, Niels Obel, Claire Thorne, Amanda Mocroft, Ole Kirk, Christoph Stephan, Santiago Pérez-Hoyos, Antoni Noguera-Julian, Andrea Antinori, Antonella d'Arminio Monforte, Norbert Brockmeyer, José Ramos, Manuel Battegay, Andri Rauch, Cristina Mussini, Pat Tookey, Jordi Casabona, Jose M Miro, Antonella Castagna, Stephane de Wit, Tessa Goetghebuer, Carlo Torti, Ramon Teira, Myriam Garrido, David Haerry, Ian Weller, Jordi Casabona, Dominique Costagliola, Antonella d'Arminio-Monforte, Manuel Battegay, Maria Prins, Frank de Wolf, Jesper Grarup, Genevieve Chene, Céline Colin, Christine Schwimmer, Guillaume Touzeau, Jesper Kjaer, Maria Paulsen, Julia Bohlius, Vincent Bouteloup, Heiner Bucher, Alessandro Cozzi-Lepri, François Dabis, Antonella d'Arminio Monforte, Frank de Wolf, Maria Dorrucci, Matthias Egger, Frederik Engsig, Hansjakob Furrer, Ole Kirk, Olivier Lambotte, Charlotte Lewden, Rebbeca Lodwick, Sophie Matheron, Laurence Meyer, Jose Miro, Amanda Mocroft, Niels Obel, Roger Paredes, Andrew Phillips, Massimo Puoti, Joanne Reekie, Caroline Sabin, Alexandra Scherrer, Colette Smit, Jonathan Sterne, Rodolphe Thiebaut, Claire Thorne, Carlo Torti, Viktor von Wyl, Linda Wittkop, Jim Young, Collaboration of Observational HIV Epidemiological Research Europe (COHERE) in EuroCoord, Charlotte Lewden, Vincent Bouteloup, Stéphane De Wit, Caroline Sabin, Amanda Mocroft, Jan Christian Wasmuth, Ard van Sighem, Ole Kirk, Niels Obel, George Panos, Jade Ghosn, François Dabis, Murielle Mary-Krause, Catherine Leport, Santiago Perez-Hoyos, Paz Sobrino-Vegas, Christoph Stephan, Antonella Castagna, Andrea Antinori, Antonella d'Arminio Monforte, Carlo Torti, Cristina Mussini, Virginia Isern, Alexandra Calmy, Ramón Teira, Matthias Egger, Jesper Grarup, Geneviève Chêne, Charlotte Lewden, Vincent Bouteloup, Giota Touloumi, Jade Ghosn, François Dabis, Murielle Mary-Krause, Catherine Leport, François Raffi, Ard van Sighem, Santiago Perez-Hoyos, Caroline Sabin, Jan Christian Wasmuth, Paz Sobrino, Santiago Perez-Cachafeiro, Niels Obel, Amanda Mocroft, Ole Kirk, Schlomo Staszewski, Christoph Stephan, Antonella Castagna, Antonella d'Arminio Monforte, Annalisa Ridolfo, Carlo Torti, Cristina Mussini, Virginia Isern, Alexandra Calmy, Stéphane De Wit, Ramón Teira, Matthias Egger, Geneviève Chêne, Robert Zangerle, Giota Touloumi, Josiane Warszawski, Laurence Meyer, François Dabis, Murielle Mary- Krause, Jade Ghosn, Catherine Leport, Frank de Wolf, Peter Reiss, Maria Prins, Heiner Bucher, Caroline Sabin, Diana Gibb, Gerd Fätkenheuer, Julia Del Amo, Niels Obel, Claire Thorne, Amanda Mocroft, Ole Kirk, Christoph Stephan, Santiago Pérez-Hoyos, Antoni Noguera-Julian, Andrea Antinori, Antonella d'Arminio Monforte, Norbert Brockmeyer, José Ramos, Manuel Battegay, Andri Rauch, Cristina Mussini, Pat Tookey, Jordi Casabona, Jose M Miro, Antonella Castagna, Stephane de Wit, Tessa Goetghebuer, Carlo Torti, Ramon Teira, Myriam Garrido, David Haerry, Ian Weller, Jordi Casabona, Dominique Costagliola, Antonella d'Arminio-Monforte, Manuel Battegay, Maria Prins, Frank de Wolf, Jesper Grarup, Genevieve Chene, Céline Colin, Christine Schwimmer, Guillaume Touzeau, Jesper Kjaer, Maria Paulsen, Julia Bohlius, Vincent Bouteloup, Heiner Bucher, Alessandro Cozzi-Lepri, François Dabis, Antonella d'Arminio Monforte, Frank de Wolf, Maria Dorrucci, Matthias Egger, Frederik Engsig, Hansjakob Furrer, Ole Kirk, Olivier Lambotte, Charlotte Lewden, Rebbeca Lodwick, Sophie Matheron, Laurence Meyer, Jose Miro, Amanda Mocroft, Niels Obel, Roger Paredes, Andrew Phillips, Massimo Puoti, Joanne Reekie, Caroline Sabin, Alexandra Scherrer, Colette Smit, Jonathan Sterne, Rodolphe Thiebaut, Claire Thorne, Carlo Torti, Viktor von Wyl, Linda Wittkop, Jim Young
Abstract
Background: Using data from a large European collaborative study, we aimed to identify the circumstances in which treated HIV-infected individuals will experience similar mortality rates to those of the general population.
Methods: Adults were eligible if they initiated combination anti-retroviral treatment (cART) between 1998 and 2008 and had one prior CD4 measurement within 6 months. Standardized mortality ratios (SMRs) and excess mortality rates compared with the general population were estimated using Poisson regression. Periods of follow-up were classified according to the current CD4 count.
Results: Of the 80 642 individuals, 70% were men, 16% were injecting drug users (IDUs), the median age was 37 years, median CD4 count 225/mm(3) at cART initiation and median follow-up was 3.5 years. The overall mortality rate was 1.2/100 person-years (PY) (men: 1.3, women: 0.9), 4.2 times as high as that in the general population (SMR for men: 3.8, for women: 7.4). Among 35 316 individuals with a CD4 count ≥500/mm(3), the mortality rate was 0.37/100 PY (SMR 1.5); mortality rates were similar to those of the general population in non-IDU men [SMR 0.9, 95% confidence interval (95% CI) 0.7-1.3] and, after 3 years, in women (SMR 1.1, 95% CI 0.7-1.7). Mortality rates in IDUs remained elevated, though a trend to decrease with longer durations with high CD4 count was seen. A prior AIDS diagnosis was associated with higher mortality.
Conclusions: Mortality patterns in most non-IDU HIV-infected individuals with high CD4 counts on cART are similar to those in the general population. The persistent role of a prior AIDS diagnosis underlines the importance of early diagnosis of HIV infection.
Source: PubMed