Long-term mortality in HIV patients virally suppressed for more than three years with incomplete CD4 recovery: a cohort study.
BACKGROUND
The mortality in patients with persistent low CD4 count despite several years of HAART with sustained viral suppression is poorly documented. We aimed to identify predictors for inadequate CD4 cell recovery and estimate mortality in patients with low CD4 count but otherwise successful HAART.


METHODS
In a nationwide cohort of HIV patients we identified all individuals who started HAART before 1 January 2005 with CD4 cell count ≤ 200 cells/μL and experienced three years with sustained viral suppression. Patients were categorized according to CD4 cell count after the three years suppressed period (≤ 200 cells/μL; immunological non-responders (INRs), >200 cells/μL; immunological responders (IRs)). We used logistic regression and Kaplan-Meier analysis to estimated risk factors and mortality for INRs compared to IRs.


RESULTS
We identified 55 INRs and 236 IRs. In adjusted analysis age > 40 years and > one year from first CD4 cell count ≤ 200 cells/μL to start of the virologically suppressed period were associated with increased risk of INR. INRs had substantially higher mortality compared to IRs. The excess mortality was mainly seen in the INR group with > one year of immunological suppression prior to viral suppression and injection drug users (IDUs).


CONCLUSIONS
Age and prolonged periods of immune deficiency prior to successful HAART are risk factors for incomplete CD4 cell recovery. INRs have substantially increased long-term mortality mainly associated with prolonged immunological suppression prior to viral suppression and IDU.
Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark. fren74@gmail.com
Frederik N
FN
Engsig
Jan
J
Gerstoft
Gitte
G
Kronborg
Carsten S
CS
Larsen
Gitte
G
Pedersen
Birgit
B
Røge
Janne
J
Jensen
Lars N
LN
Nielsen
Niels
N
Obel
D000328:Adult; D000367:Age Factors; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D023241:Antiretroviral Therapy, Highly Active; D001769:Blood / Q000821:virology*; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000401:mortality*; D006801:Humans; D007108:Immune Tolerance; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors; D019562:Viral Load
D019380:Anti-HIV Agents