title: 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.
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.
authors.affiliation: University of Toronto, Toronto, Ontario, Canada. mona.loutfy@wchospital.ca
authors.forename: Mona R
authors.initials: MR
authors.lastname: Loutfy
authors.forename: Miguel
authors.initials: M
authors.lastname: Genebat
authors.forename: David
authors.initials: D
authors.lastname: Moore
authors.forename: Janet
authors.initials: J
authors.lastname: Raboud
authors.forename: Keith
authors.initials: K
authors.lastname: Chan
authors.forename: Tony
authors.initials: T
authors.lastname: Antoniou
authors.forename: David
authors.initials: D
authors.lastname: Milan
authors.forename: Anya
authors.initials: A
authors.lastname: Shen
authors.forename: Marina B
authors.initials: MB
authors.lastname: Klein
authors.forename: Curtis
authors.initials: C
authors.lastname: Cooper
authors.forename: Nima
authors.initials: N
authors.lastname: Machouf
authors.forename: Sean B
authors.initials: SB
authors.lastname: Rourke
authors.forename: Anita
authors.initials: A
authors.lastname: Rachlis
authors.forename: Chris
authors.initials: C
authors.lastname: Tsoukas
authors.forename: Julio S G
authors.initials: JS
authors.lastname: Montaner
authors.forename: Sharon L
authors.initials: SL
authors.lastname: Walmsley
authors.forename: Marek
authors.initials: M
authors.lastname: Smieja
authors.forename: Ahmed
authors.initials: A
authors.lastname: Bayoumi
authors.forename: Edward
authors.initials: E
authors.lastname: Mills
authors.forename: Robert S
authors.initials: RS
authors.lastname: Hogg
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D016638:Critical Illness; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000401:mortality*; D015497:HIV-1; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D044966:Anti-Retroviral Agents