Long-term mortality in HIV positive individuals virally suppressed for more than three years with incomplete CD4 recovery

Frederik N Engsig, Robert Zangerle, Olga Katsarou, Francois Dabis, Peter Reiss, M John Gill, Kholoud Porter, Caroline Sabin, Andrew Riordan, Gerd Fätkenheuer, Félix Gutiérrez, Francois Raffi, Ole Kirk, Murielle Mary-Krause, Christoph Stephan, Patricia Garcia de Olalla, Jodie Guest, Hasina Samji, Antonella Castagna, Antonella d'Arminio MonforteAdriane Skaletz-Rorowski, Jose Ramos, Giuseppe Lapadula, Cristina Mussini, Lluís Force, Laurence Meyer, Fiona Lampe, Faroudy Boufassa, Heiner C Bucher, Stéphane De Wit, Greer A Burkholder, Ramon Teira, Amy C Justice, Tim R Sterling, Heidi Crane, Jan Gerstoft, Jesper Grarup, Margaret May, Geneviève Chêne, Suzanne M Ingle, Jonathan Sterne, Niels Obel, Antiretroviral Therapy Cohort Collaboration (ART-CC), Collaboration of Observational HIV Research Europe (COHERE) in EuroCoord

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Background. Some 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 three years of sustained viral suppression and (2) the association of achieved CD4 count with subsequent mortality. Methods. We included treated HIV infected adults from two large international HIV cohorts, who were virally suppressed (≤500 HIV-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. Results. Of 5550 eligible individuals, 835 (15%) did not reach CD4 count >200 cells/µL after three 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 CD4 count >200 cells/µL. Individuals with CD4 ≤200 cells/µL after three years of viral suppression had substantially increased mortality (adjusted hazard ratio 2.60; 95% confidence interval 1.86-3.61) compared to those who achieved CD4 count >200 cells/µL. 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 CD4 count >200 cells/µL have substantially increased long-term mortality.
Original languageEnglish
Pages (from-to)1312-1321
Number of pages10
JournalClinical Infectious Diseases
Early online date22 Jan 2014
Publication statusPublished - 22 Jan 2014


  • HIV
  • CD4 cell recovery
  • sustained viral suppression
  • risk factors
  • mortality


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