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

Margaret T May; Jorg-Janne  Vehreschild; Adam Trickey; Niels Obel; Peter Reiss; Fabrice Bonnet; Murielle Mary-Krause; Hasina Samji; Matthias Cavassini; Michael John Gill; Leah Shepherd; Heidi Crane; Antonella d'Arminio Monforte; Greer A Burkholder; Margaret Johnson; Paz Sobrino-Vegas; Pere Domingo; Robert Zangerle; Amy C Justice; Timothy Sterling; Jose M Miro; Jonathan Sterne; Antiretroviral Therapy Cohort Collaboration (ART-CC)

doi:10.1093/cid/ciw183

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

Margaret T May^*, Jorg-Janne Vehreschild, Adam Trickey, Niels Obel, Peter Reiss, Fabrice Bonnet, Murielle Mary-Krause, Hasina Samji, Matthias Cavassini, Michael John Gill, Leah Shepherd, Heidi Crane, Antonella d'Arminio Monforte, Greer A Burkholder, Margaret Johnson, Paz Sobrino-Vegas, Pere Domingo, Robert Zangerle, Amy C Justice, Timothy SterlingJose M Miro, Jonathan Sterne, Antiretroviral Therapy Cohort Collaboration (ART-CC)

^*Corresponding author for this work

Research output: Contribution to journal › Article (Academic Journal) › peer-review

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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 characterised.

Methods. We estimated mortality rates (MR) by time since start of ART (<0.5, 0.5-0.9, 1-2.9, 3-3.9, 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 [1996-7, 1998-9, 2000-1], AIDS and HIV-1 RNA at baseline) mortality rate ratios (MRR) by CD4 count at start of ART (0-49, 50-99, 100-199, 200-349, 350-499, ≥500 cells/μL) overall and separately according to time since start of ART.

Results. 6,344 of 37,496 patients died during 359,219 years of follow up. The MR per 1000 person-years was 32.8 (95% CI 30.2-35.5) during the first 6 months, declining to 16.0 (15.4, 16.8) during 5-9.9 years and 14.2 (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 were 0.97 (0.94-1.00), p=0.054 and 1.02 (0.98-1.07), p=0.32 among patients followed for 5-9.9 and >10 years respectively.

Conclusions. After surviving five 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.

Original language	English
Pages (from-to)	1571-1577
Number of pages	7
Journal	Clinical Infectious Diseases
Volume	62
Issue number	12
Early online date	29 Mar 2016
DOIs	https://doi.org/10.1093/cid/ciw183
Publication status	Published - 15 Jun 2016

Keywords

HIV
CD4 count
antiretroviral therapy
mortality
cohort collaboration

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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May, M. T., Vehreschild, J-J., Trickey, A., Obel, N., Reiss, P., Bonnet, F., Mary-Krause, M., Samji, H., Cavassini, M., Gill, M. J., Shepherd, L., Crane, H., d'Arminio Monforte, A., Burkholder, G. A., Johnson, M., Sobrino-Vegas, P., Domingo, P., Zangerle, R., Justice, A. C., ... Antiretroviral Therapy Cohort Collaboration (ART-CC) (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. Clinical Infectious Diseases, 62(12), 1571-1577. https://doi.org/10.1093/cid/ciw183

@article{cd61973941374103a4ccde9bfdb7a8bd,

title = "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",

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 characterised. Methods. We estimated mortality rates (MR) by time since start of ART (<0.5, 0.5-0.9, 1-2.9, 3-3.9, 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 [1996-7, 1998-9, 2000-1], AIDS and HIV-1 RNA at baseline) mortality rate ratios (MRR) by CD4 count at start of ART (0-49, 50-99, 100-199, 200-349, 350-499, ≥500 cells/μL) overall and separately according to time since start of ART. Results. 6,344 of 37,496 patients died during 359,219 years of follow up. The MR per 1000 person-years was 32.8 (95% CI 30.2-35.5) during the first 6 months, declining to 16.0 (15.4, 16.8) during 5-9.9 years and 14.2 (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 were 0.97 (0.94-1.00), p=0.054 and 1.02 (0.98-1.07), p=0.32 among patients followed for 5-9.9 and >10 years respectively. Conclusions. After surviving five 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. ",

keywords = "HIV, CD4 count, antiretroviral therapy, mortality, cohort collaboration",

author = "May, {Margaret T} and Jorg-Janne Vehreschild and Adam Trickey and Niels Obel and Peter Reiss and Fabrice Bonnet and Murielle Mary-Krause and Hasina Samji and Matthias Cavassini and Gill, {Michael John} and Leah Shepherd and Heidi Crane and {d'Arminio Monforte}, Antonella and Burkholder, {Greer A} and Margaret Johnson and Paz Sobrino-Vegas and Pere Domingo and Robert Zangerle and Justice, {Amy C} and Timothy Sterling and Miro, {Jose M} and Jonathan Sterne and {Antiretroviral Therapy Cohort Collaboration (ART-CC)} and Ingle, {Suzanne M}",

year = "2016",

month = jun,

day = "15",

doi = "10.1093/cid/ciw183",

language = "English",

volume = "62",

pages = "1571--1577",

journal = "Clinical Infectious Diseases",

issn = "1058-4838",

publisher = "Oxford University Press",

number = "12",

}

May, MT, Vehreschild, J-J, Trickey, A, Obel, N, Reiss, P, Bonnet, F, Mary-Krause, M, Samji, H, Cavassini, M, Gill, MJ, Shepherd, L, Crane, H, d'Arminio Monforte, A, Burkholder, GA, Johnson, M, Sobrino-Vegas, P, Domingo, P, Zangerle, R, Justice, AC, Sterling, T, Miro, JM, Sterne, J & Antiretroviral Therapy Cohort Collaboration (ART-CC) 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', Clinical Infectious Diseases, vol. 62, no. 12, pp. 1571-1577. https://doi.org/10.1093/cid/ciw183

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. / May, Margaret T; Vehreschild, Jorg-Janne ; Trickey, Adam et al.
In: Clinical Infectious Diseases, Vol. 62, No. 12, 15.06.2016, p. 1571-1577.

Research output: Contribution to journal › Article (Academic Journal) › peer-review

TY - JOUR

T1 - 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

T2 - collaborative cohort study

AU - May, Margaret T

AU - Vehreschild, Jorg-Janne

AU - Trickey, Adam

AU - Obel, Niels

AU - Reiss, Peter

AU - Bonnet, Fabrice

AU - Mary-Krause, Murielle

AU - Samji, Hasina

AU - Cavassini, Matthias

AU - Gill, Michael John

AU - Shepherd, Leah

AU - Crane, Heidi

AU - d'Arminio Monforte, Antonella

AU - Burkholder, Greer A

AU - Johnson, Margaret

AU - Sobrino-Vegas, Paz

AU - Domingo, Pere

AU - Zangerle, Robert

AU - Justice, Amy C

AU - Sterling, Timothy

AU - Miro, Jose M

AU - Sterne, Jonathan

AU - Antiretroviral Therapy Cohort Collaboration (ART-CC)

AU - Ingle, Suzanne M

PY - 2016/6/15

Y1 - 2016/6/15

N2 - 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 characterised. Methods. We estimated mortality rates (MR) by time since start of ART (<0.5, 0.5-0.9, 1-2.9, 3-3.9, 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 [1996-7, 1998-9, 2000-1], AIDS and HIV-1 RNA at baseline) mortality rate ratios (MRR) by CD4 count at start of ART (0-49, 50-99, 100-199, 200-349, 350-499, ≥500 cells/μL) overall and separately according to time since start of ART. Results. 6,344 of 37,496 patients died during 359,219 years of follow up. The MR per 1000 person-years was 32.8 (95% CI 30.2-35.5) during the first 6 months, declining to 16.0 (15.4, 16.8) during 5-9.9 years and 14.2 (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 were 0.97 (0.94-1.00), p=0.054 and 1.02 (0.98-1.07), p=0.32 among patients followed for 5-9.9 and >10 years respectively. Conclusions. After surviving five 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.

AB - 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 characterised. Methods. We estimated mortality rates (MR) by time since start of ART (<0.5, 0.5-0.9, 1-2.9, 3-3.9, 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 [1996-7, 1998-9, 2000-1], AIDS and HIV-1 RNA at baseline) mortality rate ratios (MRR) by CD4 count at start of ART (0-49, 50-99, 100-199, 200-349, 350-499, ≥500 cells/μL) overall and separately according to time since start of ART. Results. 6,344 of 37,496 patients died during 359,219 years of follow up. The MR per 1000 person-years was 32.8 (95% CI 30.2-35.5) during the first 6 months, declining to 16.0 (15.4, 16.8) during 5-9.9 years and 14.2 (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 were 0.97 (0.94-1.00), p=0.054 and 1.02 (0.98-1.07), p=0.32 among patients followed for 5-9.9 and >10 years respectively. Conclusions. After surviving five 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.

KW - HIV

KW - CD4 count

KW - antiretroviral therapy

KW - mortality

KW - cohort collaboration

UR - http://www.scopus.com/inward/record.url?scp=84973483975&partnerID=8YFLogxK

U2 - 10.1093/cid/ciw183

DO - 10.1093/cid/ciw183

M3 - Article (Academic Journal)

C2 - 27025828

SN - 1058-4838

VL - 62

SP - 1571

EP - 1577

JO - Clinical Infectious Diseases

JF - Clinical Infectious Diseases

IS - 12

ER -

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

Abstract

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ART-CC: Prognosis of HIV-infected patients treated with ART

MONITORING AND MODELLING PROGNOSIS IN THE ERA OF HAART

THE IMPACT OF HIGHLY EFFECTIVE ANTIRETROVIRAL THERAPY: MONITORING AND MODELLING BENEFIT AND HARM

Professor Jonathan A C Sterne

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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

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UN SDGs

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ART-CC: Prognosis of HIV-infected patients treated with ART

MONITORING AND MODELLING PROGNOSIS IN THE ERA OF HAART

THE IMPACT OF HIGHLY EFFECTIVE ANTIRETROVIRAL THERAPY: MONITORING AND MODELLING BENEFIT AND HARM

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