The incidence of AIDS-defining illnesses at a current CD4 count ≥ 200 cells/μL in the post-combination antiretroviral therapy era

A Mocroft; H J Furrer; J M Miro; P Reiss; C Mussini; O Kirk; S Abgrall; S Ayayi; B Bartmeyer; D Braun; A Castagna; A d'Arminio Monforte; B Gazzard; F Gutierrez; I Hurtado; Karina Jansen; L Meyer; P Muñoz; N Obel; P Soler-Palacin; A Papadopoulos; F Raffi; J T Ramos; J K Rockstroh; D Salmon; C Torti; J Warszawski; S de Wit; R Zangerle; C Fabre-Colin; J Kjaer; G Chene; J Grarup; J D Lundgren; Opportunistic Infections Working Group on behalf of the Collaboration of Observational HIV Epidemiological Research Europe (COHERE) study in EuroCOORD

doi:10.1093/cid/cit423

The incidence of AIDS-defining illnesses at a current CD4 count ≥ 200 cells/μL in the post-combination antiretroviral therapy era

A Mocroft, H J Furrer, J M Miro, P Reiss, C Mussini, O Kirk, S Abgrall, S Ayayi, B Bartmeyer, D Braun, A Castagna, A d'Arminio Monforte, B Gazzard, F Gutierrez, I Hurtado, Karina Jansen, L Meyer, P Muñoz, N Obel, P Soler-PalacinA Papadopoulos, F Raffi, J T Ramos, J K Rockstroh, D Salmon, C Torti, J Warszawski, S de Wit, R Zangerle, C Fabre-Colin, J Kjaer, G Chene, J Grarup, J D Lundgren, Opportunistic Infections Working Group on behalf of the Collaboration of Observational HIV Epidemiological Research Europe (COHERE) study in EuroCOORD

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Abstract

Background. Few studies consider the incidence of individual AIDS-defining illnesses (ADIs) at higher CD4 counts, relevant on a population level for monitoring and resource allocation. Methods. Individuals from the Collaboration of Observational HIV Epidemiological Research Europe (COHERE) aged ≥14 years with ≥1 CD4 count of ≥200 μL between 1998 and 2010 were included. Incidence rates (per 1000 personyears of follow-up [PYFU]) were calculated for each ADI within different CD4 strata; Poisson regression, using generalized estimating equations and robust standard errors, was used to model rates of ADIs with current CD4 ≥500/μL. Results. A total of 12 135 ADIs occurred at a CD4 count of ≥200 cells/μL among 207 539 persons with 1 154 803 PYFU. Incidence rates declined from 20.5 per 1000 PYFU (95% confidence interval [CI], 20.0-21.1 per 1000 PYFU) with current CD4 200-349 cells/μL to 4.1 per 1000 PYFU (95% CI, 3.6-4.6 per 1000 PYFU) with current CD4 ≥ 1000 cells/μL. Persons with a current CD4 of 500-749 cells/μL had a significantly higher rate of ADIs (adjusted incidence rate ratio [aIRR], 1.20; 95% CI, 1.10-1.32), whereas those with a current CD4 of ≥1000 cells/μL had a similar rate (aIRR, 0.92; 95% CI, .79-1.07), compared to a current CD4 of 750-999 cells/μL. Results were consistent in persons with high or low viral load. Findings were stronger for malignant ADIs (aIRR, 1.52; 95% CI, 1.25-1.86) than for nonmalignant ADIs (aIRR, 1.12; 95% CI, 1.01-1.25), comparing persons with a current CD4 of 500-749 cells/μL to 750-999 cells/μL. Discussion. The incidence of ADIs was higher in individuals with a current CD4 count of 500-749 cells/μL compared to those with a CD4 count of 750-999 cells/μL, but did not decrease further at higher CD4 counts. Results were similar in patients virologically suppressed on combination antiretroviral therapy, suggesting that immune reconstitution is not complete until the CD4 increases to >750 cells/μL.

Original language	English
Journal	Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
Volume	57
Issue number	7
Pages (from-to)	1038-47
Number of pages	10
DOIs	https://doi.org/10.1093/cid/cit423
Publication status	Published - 1 Oct 2013

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Mocroft, A., Furrer, H. J., Miro, J. M., Reiss, P., Mussini, C., Kirk, O., Abgrall, S., Ayayi, S., Bartmeyer, B., Braun, D., Castagna, A., d'Arminio Monforte, A., Gazzard, B., Gutierrez, F., Hurtado, I., Jansen, K., Meyer, L., Muñoz, P., Obel, N., ... Opportunistic Infections Working Group on behalf of the Collaboration of Observational HIV Epidemiological Research Europe (COHERE) study in EuroCOORD (2013). The incidence of AIDS-defining illnesses at a current CD4 count ≥ 200 cells/μL in the post-combination antiretroviral therapy era. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 57(7), 1038-47. https://doi.org/10.1093/cid/cit423

The incidence of AIDS-defining illnesses at a current CD4 count ≥ 200 cells/μL in the post-combination antiretroviral therapy era. / Mocroft, A; Furrer, H J; Miro, J M et al.

In: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, Vol. 57, No. 7, 01.10.2013, p. 1038-47.

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

Mocroft, A, Furrer, HJ, Miro, JM, Reiss, P, Mussini, C, Kirk, O, Abgrall, S, Ayayi, S, Bartmeyer, B, Braun, D, Castagna, A, d'Arminio Monforte, A, Gazzard, B, Gutierrez, F, Hurtado, I, Jansen, K, Meyer, L, Muñoz, P, Obel, N, Soler-Palacin, P, Papadopoulos, A, Raffi, F, Ramos, JT, Rockstroh, JK, Salmon, D, Torti, C, Warszawski, J, de Wit, S, Zangerle, R, Fabre-Colin, C, Kjaer, J, Chene, G, Grarup, J, Lundgren, JD & Opportunistic Infections Working Group on behalf of the Collaboration of Observational HIV Epidemiological Research Europe (COHERE) study in EuroCOORD 2013, 'The incidence of AIDS-defining illnesses at a current CD4 count ≥ 200 cells/μL in the post-combination antiretroviral therapy era', Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, vol. 57, no. 7, pp. 1038-47. https://doi.org/10.1093/cid/cit423

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title = "The incidence of AIDS-defining illnesses at a current CD4 count ≥ 200 cells/μL in the post-combination antiretroviral therapy era",

abstract = "Background. Few studies consider the incidence of individual AIDS-defining illnesses (ADIs) at higher CD4 counts, relevant on a population level for monitoring and resource allocation. Methods. Individuals from the Collaboration of Observational HIV Epidemiological Research Europe (COHERE) aged ≥14 years with ≥1 CD4 count of ≥200 μL between 1998 and 2010 were included. Incidence rates (per 1000 personyears of follow-up [PYFU]) were calculated for each ADI within different CD4 strata; Poisson regression, using generalized estimating equations and robust standard errors, was used to model rates of ADIs with current CD4 ≥500/μL. Results. A total of 12 135 ADIs occurred at a CD4 count of ≥200 cells/μL among 207 539 persons with 1 154 803 PYFU. Incidence rates declined from 20.5 per 1000 PYFU (95% confidence interval [CI], 20.0-21.1 per 1000 PYFU) with current CD4 200-349 cells/μL to 4.1 per 1000 PYFU (95% CI, 3.6-4.6 per 1000 PYFU) with current CD4 ≥ 1000 cells/μL. Persons with a current CD4 of 500-749 cells/μL had a significantly higher rate of ADIs (adjusted incidence rate ratio [aIRR], 1.20; 95% CI, 1.10-1.32), whereas those with a current CD4 of ≥1000 cells/μL had a similar rate (aIRR, 0.92; 95% CI, .79-1.07), compared to a current CD4 of 750-999 cells/μL. Results were consistent in persons with high or low viral load. Findings were stronger for malignant ADIs (aIRR, 1.52; 95% CI, 1.25-1.86) than for nonmalignant ADIs (aIRR, 1.12; 95% CI, 1.01-1.25), comparing persons with a current CD4 of 500-749 cells/μL to 750-999 cells/μL. Discussion. The incidence of ADIs was higher in individuals with a current CD4 count of 500-749 cells/μL compared to those with a CD4 count of 750-999 cells/μL, but did not decrease further at higher CD4 counts. Results were similar in patients virologically suppressed on combination antiretroviral therapy, suggesting that immune reconstitution is not complete until the CD4 increases to >750 cells/μL.",

author = "A Mocroft and Furrer, {H J} and Miro, {J M} and P Reiss and C Mussini and O Kirk and S Abgrall and S Ayayi and B Bartmeyer and D Braun and A Castagna and {d'Arminio Monforte}, A and B Gazzard and F Gutierrez and I Hurtado and Karina Jansen and L Meyer and P Mu{\~n}oz and N Obel and P Soler-Palacin and A Papadopoulos and F Raffi and Ramos, {J T} and Rockstroh, {J K} and D Salmon and C Torti and J Warszawski and {de Wit}, S and R Zangerle and C Fabre-Colin and J Kjaer and G Chene and J Grarup and Lundgren, {J D} and {Opportunistic Infections Working Group on behalf of the Collaboration of Observational HIV Epidemiological Research Europe (COHERE) study in EuroCOORD}",

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doi = "10.1093/cid/cit423",

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TY - JOUR

T1 - The incidence of AIDS-defining illnesses at a current CD4 count ≥ 200 cells/μL in the post-combination antiretroviral therapy era

AU - Mocroft, A

AU - Furrer, H J

AU - Miro, J M

AU - Reiss, P

AU - Mussini, C

AU - Kirk, O

AU - Abgrall, S

AU - Ayayi, S

AU - Bartmeyer, B

AU - Braun, D

AU - Castagna, A

AU - d'Arminio Monforte, A

AU - Gazzard, B

AU - Gutierrez, F

AU - Hurtado, I

AU - Jansen, Karina

AU - Meyer, L

AU - Muñoz, P

AU - Obel, N

AU - Soler-Palacin, P

AU - Papadopoulos, A

AU - Raffi, F

AU - Ramos, J T

AU - Rockstroh, J K

AU - Salmon, D

AU - Torti, C

AU - Warszawski, J

AU - de Wit, S

AU - Zangerle, R

AU - Fabre-Colin, C

AU - Kjaer, J

AU - Chene, G

AU - Grarup, J

AU - Lundgren, J D

AU - Opportunistic Infections Working Group on behalf of the Collaboration of Observational HIV Epidemiological Research Europe (COHERE) study in EuroCOORD

PY - 2013/10/1

Y1 - 2013/10/1

N2 - Background. Few studies consider the incidence of individual AIDS-defining illnesses (ADIs) at higher CD4 counts, relevant on a population level for monitoring and resource allocation. Methods. Individuals from the Collaboration of Observational HIV Epidemiological Research Europe (COHERE) aged ≥14 years with ≥1 CD4 count of ≥200 μL between 1998 and 2010 were included. Incidence rates (per 1000 personyears of follow-up [PYFU]) were calculated for each ADI within different CD4 strata; Poisson regression, using generalized estimating equations and robust standard errors, was used to model rates of ADIs with current CD4 ≥500/μL. Results. A total of 12 135 ADIs occurred at a CD4 count of ≥200 cells/μL among 207 539 persons with 1 154 803 PYFU. Incidence rates declined from 20.5 per 1000 PYFU (95% confidence interval [CI], 20.0-21.1 per 1000 PYFU) with current CD4 200-349 cells/μL to 4.1 per 1000 PYFU (95% CI, 3.6-4.6 per 1000 PYFU) with current CD4 ≥ 1000 cells/μL. Persons with a current CD4 of 500-749 cells/μL had a significantly higher rate of ADIs (adjusted incidence rate ratio [aIRR], 1.20; 95% CI, 1.10-1.32), whereas those with a current CD4 of ≥1000 cells/μL had a similar rate (aIRR, 0.92; 95% CI, .79-1.07), compared to a current CD4 of 750-999 cells/μL. Results were consistent in persons with high or low viral load. Findings were stronger for malignant ADIs (aIRR, 1.52; 95% CI, 1.25-1.86) than for nonmalignant ADIs (aIRR, 1.12; 95% CI, 1.01-1.25), comparing persons with a current CD4 of 500-749 cells/μL to 750-999 cells/μL. Discussion. The incidence of ADIs was higher in individuals with a current CD4 count of 500-749 cells/μL compared to those with a CD4 count of 750-999 cells/μL, but did not decrease further at higher CD4 counts. Results were similar in patients virologically suppressed on combination antiretroviral therapy, suggesting that immune reconstitution is not complete until the CD4 increases to >750 cells/μL.

AB - Background. Few studies consider the incidence of individual AIDS-defining illnesses (ADIs) at higher CD4 counts, relevant on a population level for monitoring and resource allocation. Methods. Individuals from the Collaboration of Observational HIV Epidemiological Research Europe (COHERE) aged ≥14 years with ≥1 CD4 count of ≥200 μL between 1998 and 2010 were included. Incidence rates (per 1000 personyears of follow-up [PYFU]) were calculated for each ADI within different CD4 strata; Poisson regression, using generalized estimating equations and robust standard errors, was used to model rates of ADIs with current CD4 ≥500/μL. Results. A total of 12 135 ADIs occurred at a CD4 count of ≥200 cells/μL among 207 539 persons with 1 154 803 PYFU. Incidence rates declined from 20.5 per 1000 PYFU (95% confidence interval [CI], 20.0-21.1 per 1000 PYFU) with current CD4 200-349 cells/μL to 4.1 per 1000 PYFU (95% CI, 3.6-4.6 per 1000 PYFU) with current CD4 ≥ 1000 cells/μL. Persons with a current CD4 of 500-749 cells/μL had a significantly higher rate of ADIs (adjusted incidence rate ratio [aIRR], 1.20; 95% CI, 1.10-1.32), whereas those with a current CD4 of ≥1000 cells/μL had a similar rate (aIRR, 0.92; 95% CI, .79-1.07), compared to a current CD4 of 750-999 cells/μL. Results were consistent in persons with high or low viral load. Findings were stronger for malignant ADIs (aIRR, 1.52; 95% CI, 1.25-1.86) than for nonmalignant ADIs (aIRR, 1.12; 95% CI, 1.01-1.25), comparing persons with a current CD4 of 500-749 cells/μL to 750-999 cells/μL. Discussion. The incidence of ADIs was higher in individuals with a current CD4 count of 500-749 cells/μL compared to those with a CD4 count of 750-999 cells/μL, but did not decrease further at higher CD4 counts. Results were similar in patients virologically suppressed on combination antiretroviral therapy, suggesting that immune reconstitution is not complete until the CD4 increases to >750 cells/μL.

U2 - 10.1093/cid/cit423

DO - 10.1093/cid/cit423

M3 - Journal article

C2 - 23921881

SN - 1058-4838

VL - 57

SP - 1038

EP - 1047

JO - Clinical Infectious Diseases

JF - Clinical Infectious Diseases

IS - 7

ER -

The incidence of AIDS-defining illnesses at a current CD4 count ≥ 200 cells/μL in the post-combination antiretroviral therapy era

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