title: 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.
abstract: 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/mm(3) 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/mm(3), 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.
authors.affiliation: INSERM, U897, ISPED, Université Bordeaux Segalen, Bordeaux, France. charlotte.lewden@isped.u-bordeaux2.fr
authors.forename: Charlotte
authors.initials: C
authors.lastname: Lewden
authors.forename: Vincent
authors.initials: V
authors.lastname: Bouteloup
authors.forename: Stéphane
authors.initials: S
authors.lastname: De Wit
authors.forename: Caroline
authors.initials: C
authors.lastname: Sabin
authors.forename: Amanda
authors.initials: A
authors.lastname: Mocroft
authors.forename: Jan Christian
authors.initials: JC
authors.lastname: Wasmuth
authors.forename: Ard
authors.initials: A
authors.lastname: van Sighem
authors.forename: Ole
authors.initials: O
authors.lastname: Kirk
authors.forename: Niels
authors.initials: N
authors.lastname: Obel
authors.forename: George
authors.initials: G
authors.lastname: Panos
authors.forename: Jade
authors.initials: J
authors.lastname: Ghosn
authors.forename: François
authors.initials: F
authors.lastname: Dabis
authors.forename: Murielle
authors.initials: M
authors.lastname: Mary-Krause
authors.forename: Catherine
authors.initials: C
authors.lastname: Leport
authors.forename: Santiago
authors.initials: S
authors.lastname: Perez-Hoyos
authors.forename: Paz
authors.initials: P
authors.lastname: Sobrino-Vegas
authors.forename: Christoph
authors.initials: C
authors.lastname: Stephan
authors.forename: Antonella
authors.initials: A
authors.lastname: Castagna
authors.forename: Andrea
authors.initials: A
authors.lastname: Antinori
authors.forename: Antonella
authors.initials: A
authors.lastname: d'Arminio Monforte
authors.forename: Carlo
authors.initials: C
authors.lastname: Torti
authors.forename: Cristina
authors.initials: C
authors.lastname: Mussini
authors.forename: Virginia
authors.initials: V
authors.lastname: Isern
authors.forename: Alexandra
authors.initials: A
authors.lastname: Calmy
authors.forename: Ramón
authors.initials: R
authors.lastname: Teira
authors.forename: Matthias
authors.initials: M
authors.lastname: Egger
authors.forename: Jesper
authors.initials: J
authors.lastname: Grarup
authors.forename: Geneviève
authors.initials: G
authors.lastname: Chêne
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D002423:Cause of Death; D015331:Cohort Studies; D005060:Europe / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000401:mortality*; D006801:Humans; D008297:Male; D016012:Poisson Distribution; D012307:Risk Factors
chemical_list: D019380:Anti-HIV Agents