Death rates in HIV-positive antiretroviral-naive patients with CD4 count greater than 350 cells per μl in Europe and North America

A pooled cohort observational study

Rebecca Lodwick, Rebecca K. Lodwick, Caroline A. Sabin, Kholoud Porter, Bruno Ledergerber, Ard Van Sighem, Alessandro Cozzi-Lepri, Pavel Khaykin, Amanda Mocroft, Lisa Jacobson, Stephane De Wit, Niels Obel, Antonella Castagna, Jan Christian Wasmuth, John Gill, Marina B. Klein, Stephen Gange, Melchor Riera, Cristina Mussini, Félix Gutiérrez & 5 others Giota Touloumi, Patrizia Carrieri, Jodie L. Guest, Norbert H. Brockmeyer, Andrew N. Phillips

Research output: Contribution to journalArticle

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Abstract

Summary Background Whether people living with HIV who have not received antiretroviral therapy (ART) and have high CD4 cell counts have higher mortality than the general population is unknown. We aimed to examine this by analysis of pooled data from industrialised countries. We merged data on demographics, CD4 cell counts, viral-load measurements, hepatitis C co-infection status, smoking status, date of death, and whether death was AIDS-related or not from 23 European and North American cohorts. We calculated standardised mortality ratios (SMRs) standardised by age, sex, and year, stratifying by risk group. Data were included for patients aged 20-59 years who had at least one CD4 count greater than 350 cells per μL while ART naive. All pre-ART CD4 counts greater than 350 cells per μL from January, 1990, to December, 2004, were included. We investigated mortality for four risk groups - men who have sex with men, heterosexual people, injecting drug users, and those at other or unknown risk. The association between CD4 cell count and death rate was investigated by use of Poisson regression methods. Data were analysed for 40 830 patients contributing 80 682 person-years of follow-up. Of 419 deaths, 401 were used in the SMR analysis: 100 men who have sex with men (SMR 1·30, 95 CI 1·06-1·58); 68 heterosexual people (2·94, 2·28-3·73); 203 injecting drug users (9·37, 8·13-10·75); and 30 in the other or unknown risk category (4·57, 3·09-6·53). Compared with CD4 counts of 350-499 cells per μL, death rate was lower in patients with counts of 500-699 cells per μL (adjusted rate ratio 0·77, 95 CI 0·61-0·95) and counts of 700 cells per μL (0·66, 0·52-0·85). In HIV-infected ART-naive patients with high CD4 cell counts, death rates were raised compared with the general population. In men who have sex with men this was modest, suggesting that a substantial proportion of the increased risk in other groups is due to confounding by other factors. Even though the increased risk is small, new studies of potential benefits of ART in this group are merited. European Commission, FP6. European AIDS Treatment Network (NEAT). Project number LSHP-CT-2006-037570.

Original languageEnglish
Pages (from-to)340-345
Number of pages6
JournalLancet
Volume376
Issue number9738
DOIs
Publication statusPublished - 2010

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CD4 Lymphocyte Count
North America
Observational Studies
Cohort Studies
HIV
Mortality
Heterosexuality
Drug Users
Acquired Immunodeficiency Syndrome
Cell Death
Therapeutics
Hepatitis C
Group Psychotherapy
Viral Load
Coinfection
Developed Countries
Population
Cell Count
Smoking
Demography

ASJC Scopus subject areas

  • Medicine(all)

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Death rates in HIV-positive antiretroviral-naive patients with CD4 count greater than 350 cells per μl in Europe and North America : A pooled cohort observational study. / Lodwick, Rebecca; Lodwick, Rebecca K.; Sabin, Caroline A.; Porter, Kholoud; Ledergerber, Bruno; Van Sighem, Ard; Cozzi-Lepri, Alessandro; Khaykin, Pavel; Mocroft, Amanda; Jacobson, Lisa; De Wit, Stephane; Obel, Niels; Castagna, Antonella; Wasmuth, Jan Christian; Gill, John; Klein, Marina B.; Gange, Stephen; Riera, Melchor; Mussini, Cristina; Gutiérrez, Félix; Touloumi, Giota; Carrieri, Patrizia; Guest, Jodie L.; Brockmeyer, Norbert H.; Phillips, Andrew N.

In: Lancet, Vol. 376, No. 9738, 2010, p. 340-345.

Research output: Contribution to journalArticle

Lodwick, R, Lodwick, RK, Sabin, CA, Porter, K, Ledergerber, B, Van Sighem, A, Cozzi-Lepri, A, Khaykin, P, Mocroft, A, Jacobson, L, De Wit, S, Obel, N, Castagna, A, Wasmuth, JC, Gill, J, Klein, MB, Gange, S, Riera, M, Mussini, C, Gutiérrez, F, Touloumi, G, Carrieri, P, Guest, JL, Brockmeyer, NH & Phillips, AN 2010, 'Death rates in HIV-positive antiretroviral-naive patients with CD4 count greater than 350 cells per μl in Europe and North America: A pooled cohort observational study', Lancet, vol. 376, no. 9738, pp. 340-345. https://doi.org/10.1016/S0140-6736(10)60932-4
Lodwick, Rebecca ; Lodwick, Rebecca K. ; Sabin, Caroline A. ; Porter, Kholoud ; Ledergerber, Bruno ; Van Sighem, Ard ; Cozzi-Lepri, Alessandro ; Khaykin, Pavel ; Mocroft, Amanda ; Jacobson, Lisa ; De Wit, Stephane ; Obel, Niels ; Castagna, Antonella ; Wasmuth, Jan Christian ; Gill, John ; Klein, Marina B. ; Gange, Stephen ; Riera, Melchor ; Mussini, Cristina ; Gutiérrez, Félix ; Touloumi, Giota ; Carrieri, Patrizia ; Guest, Jodie L. ; Brockmeyer, Norbert H. ; Phillips, Andrew N. / Death rates in HIV-positive antiretroviral-naive patients with CD4 count greater than 350 cells per μl in Europe and North America : A pooled cohort observational study. In: Lancet. 2010 ; Vol. 376, No. 9738. pp. 340-345.
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T1 - Death rates in HIV-positive antiretroviral-naive patients with CD4 count greater than 350 cells per μl in Europe and North America

T2 - A pooled cohort observational study

AU - Lodwick, Rebecca

AU - Lodwick, Rebecca K.

AU - Sabin, Caroline A.

AU - Porter, Kholoud

AU - Ledergerber, Bruno

AU - Van Sighem, Ard

AU - Cozzi-Lepri, Alessandro

AU - Khaykin, Pavel

AU - Mocroft, Amanda

AU - Jacobson, Lisa

AU - De Wit, Stephane

AU - Obel, Niels

AU - Castagna, Antonella

AU - Wasmuth, Jan Christian

AU - Gill, John

AU - Klein, Marina B.

AU - Gange, Stephen

AU - Riera, Melchor

AU - Mussini, Cristina

AU - Gutiérrez, Félix

AU - Touloumi, Giota

AU - Carrieri, Patrizia

AU - Guest, Jodie L.

AU - Brockmeyer, Norbert H.

AU - Phillips, Andrew N.

PY - 2010

Y1 - 2010

N2 - Summary Background Whether people living with HIV who have not received antiretroviral therapy (ART) and have high CD4 cell counts have higher mortality than the general population is unknown. We aimed to examine this by analysis of pooled data from industrialised countries. We merged data on demographics, CD4 cell counts, viral-load measurements, hepatitis C co-infection status, smoking status, date of death, and whether death was AIDS-related or not from 23 European and North American cohorts. We calculated standardised mortality ratios (SMRs) standardised by age, sex, and year, stratifying by risk group. Data were included for patients aged 20-59 years who had at least one CD4 count greater than 350 cells per μL while ART naive. All pre-ART CD4 counts greater than 350 cells per μL from January, 1990, to December, 2004, were included. We investigated mortality for four risk groups - men who have sex with men, heterosexual people, injecting drug users, and those at other or unknown risk. The association between CD4 cell count and death rate was investigated by use of Poisson regression methods. Data were analysed for 40 830 patients contributing 80 682 person-years of follow-up. Of 419 deaths, 401 were used in the SMR analysis: 100 men who have sex with men (SMR 1·30, 95 CI 1·06-1·58); 68 heterosexual people (2·94, 2·28-3·73); 203 injecting drug users (9·37, 8·13-10·75); and 30 in the other or unknown risk category (4·57, 3·09-6·53). Compared with CD4 counts of 350-499 cells per μL, death rate was lower in patients with counts of 500-699 cells per μL (adjusted rate ratio 0·77, 95 CI 0·61-0·95) and counts of 700 cells per μL (0·66, 0·52-0·85). In HIV-infected ART-naive patients with high CD4 cell counts, death rates were raised compared with the general population. In men who have sex with men this was modest, suggesting that a substantial proportion of the increased risk in other groups is due to confounding by other factors. Even though the increased risk is small, new studies of potential benefits of ART in this group are merited. European Commission, FP6. European AIDS Treatment Network (NEAT). Project number LSHP-CT-2006-037570.

AB - Summary Background Whether people living with HIV who have not received antiretroviral therapy (ART) and have high CD4 cell counts have higher mortality than the general population is unknown. We aimed to examine this by analysis of pooled data from industrialised countries. We merged data on demographics, CD4 cell counts, viral-load measurements, hepatitis C co-infection status, smoking status, date of death, and whether death was AIDS-related or not from 23 European and North American cohorts. We calculated standardised mortality ratios (SMRs) standardised by age, sex, and year, stratifying by risk group. Data were included for patients aged 20-59 years who had at least one CD4 count greater than 350 cells per μL while ART naive. All pre-ART CD4 counts greater than 350 cells per μL from January, 1990, to December, 2004, were included. We investigated mortality for four risk groups - men who have sex with men, heterosexual people, injecting drug users, and those at other or unknown risk. The association between CD4 cell count and death rate was investigated by use of Poisson regression methods. Data were analysed for 40 830 patients contributing 80 682 person-years of follow-up. Of 419 deaths, 401 were used in the SMR analysis: 100 men who have sex with men (SMR 1·30, 95 CI 1·06-1·58); 68 heterosexual people (2·94, 2·28-3·73); 203 injecting drug users (9·37, 8·13-10·75); and 30 in the other or unknown risk category (4·57, 3·09-6·53). Compared with CD4 counts of 350-499 cells per μL, death rate was lower in patients with counts of 500-699 cells per μL (adjusted rate ratio 0·77, 95 CI 0·61-0·95) and counts of 700 cells per μL (0·66, 0·52-0·85). In HIV-infected ART-naive patients with high CD4 cell counts, death rates were raised compared with the general population. In men who have sex with men this was modest, suggesting that a substantial proportion of the increased risk in other groups is due to confounding by other factors. Even though the increased risk is small, new studies of potential benefits of ART in this group are merited. European Commission, FP6. European AIDS Treatment Network (NEAT). Project number LSHP-CT-2006-037570.

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