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

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; Collaboration of Observational HIV Epidemiological Research Europe (COHERE) in EuroCoord

doi:10.1093/ije/dyr164

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

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 MonforteCarlo Torti, Cristina Mussini, Virginia Isern, Alexandra Calmy, Ramón Teira, Matthias Egger, Jesper Grarup, Geneviève Chêne, Collaboration of Observational HIV Epidemiological Research Europe (COHERE) in EuroCoord

193 Citations (Scopus)

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/mm³ 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/mm³, 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. Published by Oxford University Press on behalf of the International Epidemiological Association

Original language	English
Journal	International Journal of Epidemiology
Volume	41
Issue number	2
Pages (from-to)	433-45
Number of pages	13
ISSN	0300-5771
DOIs	https://doi.org/10.1093/ije/dyr164
Publication status	Published - Apr 2012

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Lewden, C., Bouteloup, V., De Wit, S., Sabin, C., Mocroft, A., Wasmuth, J. C., van Sighem, A., Kirk, O., Obel, N., Panos, G., Ghosn, J., Dabis, F., Mary-Krause, M., Leport, C., Perez-Hoyos, S., Sobrino-Vegas, P., Stephan, C., Castagna, A., Antinori, A., ... Collaboration of Observational HIV Epidemiological Research Europe (COHERE) in EuroCoord (2012). 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. International Journal of Epidemiology, 41(2), 433-45. https://doi.org/10.1093/ije/dyr164

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. / Lewden, Charlotte; Bouteloup, Vincent; De Wit, Stéphane et al.

In: International Journal of Epidemiology, Vol. 41, No. 2, 04.2012, p. 433-45.

Research output: Contribution to journal › Journal article › Research › peer-review

Lewden, C, Bouteloup, V, De Wit, S, Sabin, C, Mocroft, A, Wasmuth, JC, van Sighem, A, Kirk, O , Obel, N, Panos, G, Ghosn, J, Dabis, F, Mary-Krause, M, Leport, C, Perez-Hoyos, S, Sobrino-Vegas, P, Stephan, C, Castagna, A, Antinori, A, d'Arminio Monforte, A, Torti, C, Mussini, C, Isern, V, Calmy, A, Teira, R, Egger, M, Grarup, J, Chêne, G & Collaboration of Observational HIV Epidemiological Research Europe (COHERE) in EuroCoord 2012, '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', International Journal of Epidemiology, vol. 41, no. 2, pp. 433-45. https://doi.org/10.1093/ije/dyr164

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title = "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",

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/mm3 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/mm3, 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. Published by Oxford University Press on behalf of the International Epidemiological Association",

author = "Charlotte Lewden and Vincent Bouteloup and {De Wit}, St{\'e}phane and Caroline Sabin and Amanda Mocroft and Wasmuth, {Jan Christian} and {van Sighem}, Ard and Ole Kirk and Niels Obel and George Panos and Jade Ghosn and Fran{\c c}ois Dabis and Murielle Mary-Krause and Catherine Leport and Santiago Perez-Hoyos and Paz Sobrino-Vegas and Christoph Stephan and Antonella Castagna and Andrea Antinori and {d'Arminio Monforte}, Antonella and Carlo Torti and Cristina Mussini and Virginia Isern and Alexandra Calmy and Ram{\'o}n Teira and Matthias Egger and Jesper Grarup and Genevi{\`e}ve Ch{\^e}ne and Niels Obel",

year = "2012",

month = apr,

doi = "10.1093/ije/dyr164",

language = "English",

volume = "41",

pages = "433--45",

journal = "International Journal of Epidemiology",

issn = "0300-5771",

publisher = "Oxford University Press",

number = "2",

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TY - JOUR

T1 - All-cause mortality in treated HIV-infected adults with CD4 ≥500/mm3 compared with the general population

T2 - evidence from a large European observational cohort collaboration

AU - Lewden, Charlotte

AU - Bouteloup, Vincent

AU - De Wit, Stéphane

AU - Sabin, Caroline

AU - Mocroft, Amanda

AU - Wasmuth, Jan Christian

AU - van Sighem, Ard

AU - Kirk, Ole

AU - Obel, Niels

AU - Panos, George

AU - Ghosn, Jade

AU - Dabis, François

AU - Mary-Krause, Murielle

AU - Leport, Catherine

AU - Perez-Hoyos, Santiago

AU - Sobrino-Vegas, Paz

AU - Stephan, Christoph

AU - Castagna, Antonella

AU - Antinori, Andrea

AU - d'Arminio Monforte, Antonella

AU - Torti, Carlo

AU - Mussini, Cristina

AU - Isern, Virginia

AU - Calmy, Alexandra

AU - Teira, Ramón

AU - Egger, Matthias

AU - Grarup, Jesper

AU - Chêne, Geneviève

AU - Collaboration of Observational HIV Epidemiological Research Europe (COHERE) in EuroCoord

PY - 2012/4

Y1 - 2012/4

N2 - 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/mm3 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/mm3, 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. Published by Oxford University Press on behalf of the International Epidemiological Association

AB - 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/mm3 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/mm3, 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. Published by Oxford University Press on behalf of the International Epidemiological Association

U2 - 10.1093/ije/dyr164

DO - 10.1093/ije/dyr164

M3 - Journal article

C2 - 22493325

SN - 0300-5771

VL - 41

SP - 433

EP - 445

JO - International Journal of Epidemiology

JF - International Journal of Epidemiology

IS - 2

ER -

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

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