Long-term Mortality in HIV-Positive Individuals Virally
Suppressed for >3 Years With Incomplete CD4 Recovery

Frederik N Engsig; Robert Zangerle; Olga Katsarou; Francois Dabis; Peter Reiss; 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 Monforte; Adriane 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 M Crane; Jan Gerstoft; Jesper Grarup; Margaret May; Geneviève Chêne; Suzanne M Ingle; Jonathan Sterne; Niels Obel; Antiretroviral Therapy Cohort Collaboration (ART-CC) and the Collaboration of Observational HIV Epidemiological Research Europe (COHERE) in EuroCoord

doi:10.1093/cid/ciu038

Long-term Mortality in HIV-Positive Individuals Virally Suppressed for >3 Years With Incomplete CD4 Recovery

Frederik N Engsig, Robert Zangerle, Olga Katsarou, Francois Dabis, Peter Reiss, 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 M Crane, Jan Gerstoft, Jesper Grarup, Margaret May, Geneviève Chêne, Suzanne M Ingle, Jonathan Sterne, Niels Obel, Antiretroviral Therapy Cohort Collaboration (ART-CC) and the Collaboration of Observational HIV Epidemiological Research Europe (COHERE) in EuroCoord

Department of Clinical Medicine

84 Citations (Scopus)

Abstract

BACKGROUND: Some human immunodeficiency virus (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 3 years of sustained viral suppression and (2) the association of the achieved CD4 count with subsequent mortality.

METHODS: We included treated HIV-infected adults from 2 large international HIV cohorts, who had viral suppression (≤500 HIV type 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 a CD4 count >200 cells/µL after 3 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 a CD4 count >200 cells/µL. Individuals with CD4 ≤200 cells/µL after 3 years of viral suppression had substantially increased mortality (adjusted hazard ratio, 2.60; 95% confidence interval, 1.86-3.61) compared with 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 a CD4 count >200 cells/µL have substantially increased long-term mortality.

Original language	English
Journal	Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
Volume	58
Issue number	9
Pages (from-to)	1312-1321
Number of pages	10
ISSN	1058-4838
DOIs	https://doi.org/10.1093/cid/ciu038
Publication status	Published - 1 May 2014

Keywords

Adult
Anti-HIV Agents
CD4 Lymphocyte Count
Cause of Death
Cohort Studies
Female
HIV Infections
Heterosexuality
Humans
Logistic Models
Male
Middle Aged
Risk Factors
Substance-Related Disorders
Viral Load

UN SDGs

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

Access to Document

10.1093/cid/ciu038

Cite this

Engsig, F. N., Zangerle, R., Katsarou, O., Dabis, F., Reiss, P., Gill, J., Porter, K., Sabin, C., Riordan, A., Fätkenheuer, G., Gutiérrez, F., Raffi, F., Kirk, O., Mary-Krause, M., Stephan, C., de Olalla, P. G., Guest, J., Samji, H., Castagna, A., ... Antiretroviral Therapy Cohort Collaboration (ART-CC) and the Collaboration of Observational HIV Epidemiological Research Europe (COHERE) in EuroCoord (2014). Long-term Mortality in HIV-Positive Individuals Virally Suppressed for >3 Years With Incomplete CD4 Recovery. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 58(9), 1312-1321. https://doi.org/10.1093/cid/ciu038

Long-term Mortality in HIV-Positive Individuals Virally Suppressed for >3 Years With Incomplete CD4 Recovery. / Engsig, Frederik N; Zangerle, Robert; Katsarou, Olga et al.
In: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, Vol. 58, No. 9, 01.05.2014, p. 1312-1321.

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

Engsig, FN, Zangerle, R, Katsarou, O, Dabis, F, Reiss, P, Gill, J, Porter, K, Sabin, C, Riordan, A, Fätkenheuer, G, Gutiérrez, F, Raffi, F, Kirk, O, Mary-Krause, M, Stephan, C, de Olalla, PG, Guest, J, Samji, H, Castagna, A, d'Arminio Monforte, A, Skaletz-Rorowski, A, Ramos, J, Lapadula, G, Mussini, C, Force, L, Meyer, L, Lampe, F, Boufassa, F, Bucher, HC, De Wit, S, Burkholder, GA, Teira, R, Justice, AC, Sterling, TR, M Crane, H, Gerstoft, J, Grarup, J, May, M, Chêne, G, Ingle, SM, Sterne, J, Obel, N & Antiretroviral Therapy Cohort Collaboration (ART-CC) and the Collaboration of Observational HIV Epidemiological Research Europe (COHERE) in EuroCoord 2014, 'Long-term Mortality in HIV-Positive Individuals Virally Suppressed for >3 Years With Incomplete CD4 Recovery', Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, vol. 58, no. 9, pp. 1312-1321. https://doi.org/10.1093/cid/ciu038

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abstract = "BACKGROUND: Some human immunodeficiency virus (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 3 years of sustained viral suppression and (2) the association of the achieved CD4 count with subsequent mortality.METHODS: We included treated HIV-infected adults from 2 large international HIV cohorts, who had viral suppression (≤500 HIV type 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 a CD4 count >200 cells/µL after 3 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 a CD4 count >200 cells/µL. Individuals with CD4 ≤200 cells/µL after 3 years of viral suppression had substantially increased mortality (adjusted hazard ratio, 2.60; 95% confidence interval, 1.86-3.61) compared with 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 a CD4 count >200 cells/µL have substantially increased long-term mortality.",

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TY - JOUR

T1 - Long-term Mortality in HIV-Positive Individuals Virally Suppressed for >3 Years With Incomplete CD4 Recovery

AU - Engsig, Frederik N

AU - Zangerle, Robert

AU - Katsarou, Olga

AU - Dabis, Francois

AU - Reiss, Peter

AU - Gill, John

AU - Porter, Kholoud

AU - Sabin, Caroline

AU - Riordan, Andrew

AU - Fätkenheuer, Gerd

AU - Gutiérrez, Félix

AU - Raffi, Francois

AU - Kirk, Ole

AU - Mary-Krause, Murielle

AU - Stephan, Christoph

AU - de Olalla, Patricia Garcia

AU - Guest, Jodie

AU - Samji, Hasina

AU - Castagna, Antonella

AU - d'Arminio Monforte, Antonella

AU - Skaletz-Rorowski, Adriane

AU - Ramos, Jose

AU - Lapadula, Giuseppe

AU - Mussini, Cristina

AU - Force, Lluís

AU - Meyer, Laurence

AU - Lampe, Fiona

AU - Boufassa, Faroudy

AU - Bucher, Heiner C

AU - De Wit, Stéphane

AU - Burkholder, Greer A

AU - Teira, Ramon

AU - Justice, Amy C

AU - Sterling, Tim R

AU - M Crane, Heidi

AU - Gerstoft, Jan

AU - Grarup, Jesper

AU - May, Margaret

AU - Chêne, Geneviève

AU - Ingle, Suzanne M

AU - Sterne, Jonathan

AU - Obel, Niels

AU - Antiretroviral Therapy Cohort Collaboration (ART-CC) and the Collaboration of Observational HIV Epidemiological Research Europe (COHERE) in EuroCoord

PY - 2014/5/1

Y1 - 2014/5/1

N2 - BACKGROUND: Some human immunodeficiency virus (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 3 years of sustained viral suppression and (2) the association of the achieved CD4 count with subsequent mortality.METHODS: We included treated HIV-infected adults from 2 large international HIV cohorts, who had viral suppression (≤500 HIV type 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 a CD4 count >200 cells/µL after 3 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 a CD4 count >200 cells/µL. Individuals with CD4 ≤200 cells/µL after 3 years of viral suppression had substantially increased mortality (adjusted hazard ratio, 2.60; 95% confidence interval, 1.86-3.61) compared with 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 a CD4 count >200 cells/µL have substantially increased long-term mortality.

AB - BACKGROUND: Some human immunodeficiency virus (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 3 years of sustained viral suppression and (2) the association of the achieved CD4 count with subsequent mortality.METHODS: We included treated HIV-infected adults from 2 large international HIV cohorts, who had viral suppression (≤500 HIV type 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 a CD4 count >200 cells/µL after 3 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 a CD4 count >200 cells/µL. Individuals with CD4 ≤200 cells/µL after 3 years of viral suppression had substantially increased mortality (adjusted hazard ratio, 2.60; 95% confidence interval, 1.86-3.61) compared with 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 a CD4 count >200 cells/µL have substantially increased long-term mortality.

KW - Adult

KW - Anti-HIV Agents

KW - CD4 Lymphocyte Count

KW - Cause of Death

KW - Cohort Studies

KW - Female

KW - HIV Infections

KW - Heterosexuality

KW - Humans

KW - Logistic Models

KW - Male

KW - Middle Aged

KW - Risk Factors

KW - Substance-Related Disorders

KW - Viral Load

U2 - 10.1093/cid/ciu038

DO - 10.1093/cid/ciu038

M3 - Journal article

C2 - 24457342

SN - 1058-4838

VL - 58

SP - 1312

EP - 1321

JO - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

JF - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

IS - 9