A CD4+ cell count <200 cells per cubic millimeter at 2 years after initiation of combination antiretroviral therapy is associated with increased mortality in HIV-infected individuals with viral suppression

Loutfy, Mona R, Genebat, Miguel, Moore, David, Raboud, Janet, Chan, Keith, Antoniou, Tony, Milan, David, Shen, Anya, Klein, Marina B, Cooper, Curtis, Machouf, Nima, Rourke, Sean B, Rachlis, Anita, Tsoukas, Chris, Montaner, Julio S G, Walmsley, Sharon L, Smieja, Marek, Bayoumi, Ahmed, Mills, Edward, Hogg, Robert S, The CANOC Collaboration, and Fisher, Martin (2010) A CD4+ cell count <200 cells per cubic millimeter at 2 years after initiation of combination antiretroviral therapy is associated with increased mortality in HIV-infected individuals with viral suppression. Journal of Acquired Immune Deficiency Syndromes, 55 (4). pp. 451-459. ISSN 1525-4135

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Abstract

OBJECTIVE

To determine the long-term impact of immunologic discordance (viral load <50 copies/mL and CD4+ count <=200 cells/mm3) in antiretroviral-naive patients initiating combination antiretroviral therapy (cART).

METHODS

Our analysis included antiretroviral-naive individuals from a population-based Canadian Observational Cohort that initiated cART after January 1, 2000, and achieved virologic suppression. Multivariable Cox proportional hazards regression was used to examine the association between 1-year and 2-year immunologic discordance and time to death from all-causes. Correlates of immunologic discordance were assessed with logistic regression.

RESULTS

Immunologic discordance was observed in 19.9% (404 of 2028) and 10.2% (176 of 1721) of individuals at 1 and 2 years after cART initiation, respectively. Two-year immunologic discordance was associated with an increased risk of death [adjusted hazard ratio = 2.69; 95% confidence interval (CI): 1.26 to 5.78]. One-year immunologic discordance was not associated with death (adjusted hazard ratio = 1.12; 95% CI: 0.54 to 2.30). Two-year immunologic discordance was associated with older age (aOR per decade = 1.23; 95% CI: 1.03 to 1.48), male gender (aOR = 1.86; 95% CI: 1.09 to 3.16), injection drug use (aOR = 2.75; 95% CI: 1.81 to 4.17), and lower baseline CD4+ count (aOR per 100 cells = 0.24; 95% CI: 0.19 to 0.31) and viral load (aOR per log10 copies/mL = 0.46; 95% CI: 0.33 to 0.65).

CONCLUSIONS

Immunologic discordance after 2 years of cART in antiretroviral-naive individuals was significantly associated with an increased risk of mortality.

Item Type: Article
Additional Information: Martin Fisher is not a named author of this article but is a member of the CANOC Collaboration.
Schools and Departments: Brighton and Sussex Medical School > Brighton and Sussex Medical School
Subjects: R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine > RA0643 Communicable diseases and public health > RA0644 Individual diseases or groups of diseases, A-Z > RA0644.A25 AIDS. HIV infections
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Depositing User: Ellen Thomas
Date Deposited: 31 Mar 2014 13:54
Last Modified: 31 Mar 2014 13:54
URI: http://sro.sussex.ac.uk/id/eprint/47546
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