Mortality of treated HIV-1 positive individuals according to viral subtype in Europe and Canada: collaborative cohort analysis

Margaret T May*, Michael J Gill, Linda Wittkop, Marina Klein, Caroline Sabin, P Richard Harrigan, David Dunn, Jorg Jane Vehreschild, Rafael Rubio, Amanda Mocroft, Matthias Cavassini, Peter Reiss, Antonella D'Arminio Monforte, Robert Zangerle, Suzanne M Ingle, Teresa Hill, Sophie Jose, Jonathan A C Sterne, Antiretroviral Therapy Cohort Collaboration (ART-CC)

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

5 Citations (Scopus)
223 Downloads (Pure)


Objectives: To estimate prognosis by viral subtype in HIV-1-infected individuals from start of antiretroviral therapy (ART) and after viral failure.

Design: Collaborative analysis of data from eight European and three Canadian cohorts.

Methods: Adults (N>20 000) who started triple ART between 1996 and 2012 and had data on viral subtype were followed for mortality. We estimated crude and adjusted (for age, sex, regimen, CD4+ cell count, and AIDS at baseline, period of starting ART, stratified by cohort, region of origin and risk group) mortality hazard ratios (MHR) by subtype. We estimated MHR subsequent to viral failure defined as two HIV-RNA measurements greater than 500 copies/ml after achieving viral suppression.

Results: The most prevalent subtypes were B (15 419; 74%), C (2091; 10%), CRF02AG (1057; 5%), A (873; 4%), CRF01AE (506; 2.4%), G (359; 1.7%), and D (232; 1.1%). Subtypes were strongly patterned by region of origin and risk group. During 104 649 person-years of observation, 1172/20 784 patients died. Compared with subtype B, mortality was higher for subtype A, but similar for all other subtypes. MHR for A versus B were 1.13 (95% confidence interval 0.85,1.50) when stratified by cohort, increased to 1.78 (1.27,2.51) on stratification by region and risk, and attenuated to 1.59 (1.14,2.23) on adjustment for covariates. MHR for A versus B was 2.65 (1.64,4.28) and 0.95 (0.57,1.57) for patients who started ART with CD4+ cell count below, or more than, 100 cells/ml, respectively. There was no difference in mortality between subtypes A, B and C after viral failure.

Conclusion: Patients with subtype A had worse prognosis, an observation which may be confounded by socio-demographic factors.

Original languageEnglish
Pages (from-to)503-513
Number of pages11
Issue number3
Publication statusPublished - 28 Jan 2016


  • Antiretroviral therapy
  • HIV-1 subtype
  • Mortality
  • Prognosis
  • Viral failure

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