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 S., Robert Zangerle, Giota Touloumi, Josiane Warszawski, Laurence Meyer, Peter Reiss, Frank de Wolf, Heiner Bucher, Maria Prins, Diana Gibb, Gerd Fätkenheuer, Julia Del Amo, Claire Thorne, Santiago Pérez-Hoyos, Antoni Noguera-Julian, Norbert Brockmeyer, José Ramos, Manuel Battegay, Andri Rauch, Pat Tookey, Jordi Casabona, Jose M. Miró, Tessa Goetghebuer, Ramon Teira, Myriam Garrido, David Haerry, Ian Weller, Dominique Costagliola, Genevieve Chene, François Raffi, Paz Sobrino, Santiago Perez-Cachafeiro, Amanda Mocroft, Ole Kirk, Schlomo Staszewski, Annalisa Ridolfo, Céline Colin, Christine Schwimmer, Guillaume Touzeau, Jesper Kjaer, Maria Paulsen, Julia Bohlius, Heiner Bucher, Alessandro Cozzi-Lepri, Maria Dorrucci, Hansjakob Furrer, Ole Kirk, Olivier Lambotte, Rebbeca Lodwick, Sophie Matheron, Jose Miro, Amanda Mocroft, Roger Paredes, Andrew Phillips, Massimo Puoti, Joanne Reekie, Alexandra Scherrer, Colette Smit, Jonathan Sterne, Rodolphe Thiebaut, Viktor von Wyl, Linda Wittkop, Jim Young

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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 languageEnglish
Article numberdyr164
Pages (from-to)433-445
Number of pages13
JournalInternational Journal of Epidemiology
Issue number2
Publication statusPublished - Apr 2012


  • Anti-retroviral therapy
  • CD4 lymphocyte count
  • Highly active
  • HIV infection
  • Mortality

ASJC Scopus subject areas

  • Epidemiology


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