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 C Shepherd; Heidi M Crane; Antonella d'Arminio Monforte; Greer A Burkholder; Margaret M Johnson; Paz Sobrino-Vegas; Pere Domingo; Robert Zangerle; Amy C Justice; Timothy R Sterling; José M Miró; Jonathan A C Sterne

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 C Shepherd, Heidi M Crane, Antonella d'Arminio Monforte, Greer A Burkholder, Margaret M Johnson, Paz Sobrino-Vegas, Pere Domingo, Robert Zangerle, Amy C Justice, Timothy R SterlingJosé M Miró, Jonathan A C Sterne

Institut for Klinisk Medicin

32 Citationer (Scopus)

225 Downloads (Pure)

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 characterized. Methods. We estimated mortality rates (MRs) by time since start of ART (<0.5, 0.5-0.9, 1-2.9, 3-4.9, 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 [1996-1997, 1998-1999, 2000-2001], and AIDS and human immunodeficiency virus type 1 RNA at baseline) mortality rate ratios (MRRs) 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. A total of 6344 of 37 496 patients died during 359 219 years of follow-up. The MR per 1000 person-years was 32.8 (95% confidence interval [CI], 30.2-35.5) during the first 6 months, declining to 16.0 (95% CI, 15.4-16.8) during 5-9.9 years and 14.2 (95% CI, 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 was 0.97 (95% CI,. 94-1.00; P =. 054) and 1.02 (95% CI,. 98-1.07; P =. 32) among patients followed for 5-9.9 and ≥10 years, respectively. Conclusions. After surviving 5 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.

Originalsprog	Engelsk
Tidsskrift	Clinical Infectious Diseases
Vol/bind	62
Udgave nummer	12
Sider (fra-til)	1571-1577
Antal sider	7
ISSN	1058-4838
DOI	https://doi.org/10.1093/cid/ciw183
Status	Udgivet - 15 jun. 2016

FN’s Verdensmål

Dette resultat bidrager til følgende verdensmål

Adgang til dokumentet

10.1093/cid/ciw183Licens: CC BY

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 StudyForlagets udgivne version, 261 KBLicens: CC BY

Citationsformater

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. C., Crane, H. M., d'Arminio Monforte, A., Burkholder, G. A., Johnson, M. M., Sobrino-Vegas, P., Domingo, P., Zangerle, R., Justice, A. C., ... Sterne, J. A. C. (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

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.

I: Clinical Infectious Diseases, Bind 62, Nr. 12, 15.06.2016, s. 1571-1577.

Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › peer review

May, MT, Vehreschild, J-J, Trickey, A, Obel, N, Reiss, P, Bonnet, F, Mary-Krause, M, Samji, H, Cavassini, M, Gill, MJ, Shepherd, LC, Crane, HM, d'Arminio Monforte, A, Burkholder, GA, Johnson, MM, Sobrino-Vegas, P, Domingo, P, Zangerle, R, Justice, AC, Sterling, TR, Miró, JM & Sterne, JAC 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, bind 62, nr. 12, s. 1571-1577. https://doi.org/10.1093/cid/ciw183

@article{ea55d48ec58a4a0abd6ba9d41e773ca9,

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 characterized. Methods. We estimated mortality rates (MRs) by time since start of ART (<0.5, 0.5-0.9, 1-2.9, 3-4.9, 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 [1996-1997, 1998-1999, 2000-2001], and AIDS and human immunodeficiency virus type 1 RNA at baseline) mortality rate ratios (MRRs) 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. A total of 6344 of 37 496 patients died during 359 219 years of follow-up. The MR per 1000 person-years was 32.8 (95% confidence interval [CI], 30.2-35.5) during the first 6 months, declining to 16.0 (95% CI, 15.4-16.8) during 5-9.9 years and 14.2 (95% CI, 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 was 0.97 (95% CI,. 94-1.00; P =. 054) and 1.02 (95% CI,. 98-1.07; P =. 32) among patients followed for 5-9.9 and ≥10 years, respectively. Conclusions. After surviving 5 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.",

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 Shepherd, {Leah C} and Crane, {Heidi M} and {d'Arminio Monforte}, Antonella and Burkholder, {Greer A} and Johnson, {Margaret M} and Paz Sobrino-Vegas and Pere Domingo and Robert Zangerle and Justice, {Amy C} and Sterling, {Timothy R} and Mir{\'o}, {Jos{\'e} M} and Sterne, {Jonathan A C}",

note = "{\textcopyright} The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America.",

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",

}

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 C

AU - Crane, Heidi M

AU - d'Arminio Monforte, Antonella

AU - Burkholder, Greer A

AU - Johnson, Margaret M

AU - Sobrino-Vegas, Paz

AU - Domingo, Pere

AU - Zangerle, Robert

AU - Justice, Amy C

AU - Sterling, Timothy R

AU - Miró, José M

AU - Sterne, Jonathan A C

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 characterized. Methods. We estimated mortality rates (MRs) by time since start of ART (<0.5, 0.5-0.9, 1-2.9, 3-4.9, 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 [1996-1997, 1998-1999, 2000-2001], and AIDS and human immunodeficiency virus type 1 RNA at baseline) mortality rate ratios (MRRs) 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. A total of 6344 of 37 496 patients died during 359 219 years of follow-up. The MR per 1000 person-years was 32.8 (95% confidence interval [CI], 30.2-35.5) during the first 6 months, declining to 16.0 (95% CI, 15.4-16.8) during 5-9.9 years and 14.2 (95% CI, 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 was 0.97 (95% CI,. 94-1.00; P =. 054) and 1.02 (95% CI,. 98-1.07; P =. 32) among patients followed for 5-9.9 and ≥10 years, respectively. Conclusions. After surviving 5 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 characterized. Methods. We estimated mortality rates (MRs) by time since start of ART (<0.5, 0.5-0.9, 1-2.9, 3-4.9, 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 [1996-1997, 1998-1999, 2000-2001], and AIDS and human immunodeficiency virus type 1 RNA at baseline) mortality rate ratios (MRRs) 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. A total of 6344 of 37 496 patients died during 359 219 years of follow-up. The MR per 1000 person-years was 32.8 (95% confidence interval [CI], 30.2-35.5) during the first 6 months, declining to 16.0 (95% CI, 15.4-16.8) during 5-9.9 years and 14.2 (95% CI, 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 was 0.97 (95% CI,. 94-1.00; P =. 054) and 1.02 (95% CI,. 98-1.07; P =. 32) among patients followed for 5-9.9 and ≥10 years, respectively. Conclusions. After surviving 5 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.

U2 - 10.1093/cid/ciw183

DO - 10.1093/cid/ciw183

M3 - Journal article

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

FN’s Verdensmål

Adgang til dokumentet

Fingeraftryk

Citationsformater