title: Mortality According to CD4 Count at Start of Combination Antiretroviral Therapy Among HIV-infected Patients Followed for up to 15 Years After Start of Treatment: Collaborative Cohort Study.
abstract: CD4 count at start of combination antiretroviral therapy (ART) is strongly associated with short-term survival, but its association with longer-term survival is less well characterized.
  
  
  
  We estimated mortality rates (MRs) by time since start of ART (<0.5, 0.5-0.9, 1-2.9, 3-4.9, 5-9.9, and ≥10 years) among patients from 18 European and North American cohorts who started ART during 1996-2001. Piecewise exponential models stratified by cohort were used to estimate crude and adjusted (for sex, age, transmission risk, period of starting ART [1996-1997, 1998-1999, 2000-2001], and AIDS and human immunodeficiency virus type 1 RNA at baseline) mortality rate ratios (MRRs) by CD4 count at start of ART (0-49, 50-99, 100-199, 200-349, 350-499, ≥500 cells/µL) overall and separately according to time since start of ART.
  
  
  
  A total of 6344 of 37 496 patients died during 359 219 years of follow-up. The MR per 1000 person-years was 32.8 (95% confidence interval [CI], 30.2-35.5) during the first 6 months, declining to 16.0 (95% CI, 15.4-16.8) during 5-9.9 years and 14.2 (95% CI, 13.3-15.1) after 10 years' duration of ART. During the first year of ART, there was a strong inverse association of CD4 count at start of ART with mortality. This diminished over the next 4 years. The adjusted MRR per CD4 group was 0.97 (95% CI, .94-1.00; P = .054) and 1.02 (95% CI, .98-1.07; P = .32) among patients followed for 5-9.9 and ≥10 years, respectively.
  
  
  
  After surviving 5 years of ART, the mortality of patients who started ART with low baseline CD4 count converged with mortality of patients with intermediate and high baseline CD4 counts.
authors.affiliation: Schoolof Social and Community Medicine, University of Bristol, United Kingdom.
authors.forename: Margaret T
authors.initials: MT
authors.lastname: May
authors.affiliation: Clinical Trials Unit II Infectious Diseases, University of Cologne, Germany.
authors.forename: Jorg-Janne
authors.initials: JJ
authors.lastname: Vehreschild
authors.affiliation: Schoolof Social and Community Medicine, University of Bristol, United Kingdom.
authors.forename: Adam
authors.initials: A
authors.lastname: Trickey
authors.affiliation: Department of Infectious Diseases, Copenhagen University Hospital, Denmark.
authors.forename: Niels
authors.initials: N
authors.lastname: Obel
authors.affiliation: Department of Global Health, Academic Medical Center, University of Amsterdam, and Amsterdam Institute of Global Health and Development HIV Monitoring Foundation.|Department of Internal Medicine, Division of Infectious Diseases, Center for Infection and Immunity-Amsterdam, Academic Medical Center, The Netherlands.
authors.forename: Peter
authors.initials: P
authors.lastname: Reiss
authors.affiliation: Bordeaux University, ISPED, INSERM U897.|CHU de Bordeaux.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Bonnet
authors.affiliation: Sorbonne Universités, UPMC Université Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France.
authors.forename: Murielle
authors.initials: M
authors.lastname: Mary-Krause
authors.affiliation: Division of Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.
authors.forename: Hasina
authors.initials: H
authors.lastname: Samji
authors.affiliation: Service of Infectious Diseases, Lausanne University Hospital and University of Lausanne, Switzerland.
authors.forename: Matthias
authors.initials: M
authors.lastname: Cavassini
authors.affiliation: Division of Infectious Diseases, University of Calgary, Canada.
authors.forename: Michael John
authors.initials: MJ
authors.lastname: Gill
authors.affiliation: Research Department of Infection and Population Health, University College London Medical School, United Kingdom.
authors.forename: Leah C
authors.initials: LC
authors.lastname: Shepherd
authors.affiliation: Center for AIDS Research, University of Washington, Seattle.
authors.forename: Heidi M
authors.initials: HM
authors.lastname: Crane
authors.affiliation: Monforte Clinic of Infectious Diseases and Tropical Medicine, San Paolo Hospital, University of Milan, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: d'Arminio Monforte
authors.affiliation: Division of Infectious Disease, Department of Medicine, University of Alabama, Birmingham.
authors.forename: Greer A
authors.initials: GA
authors.lastname: Burkholder
authors.affiliation: Department of HIV Medicine, Royal Free London NHS Foundation Trust, United Kingdom.
authors.forename: Margaret M
authors.initials: MM
authors.lastname: Johnson
authors.affiliation: Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid.
authors.forename: Paz
authors.initials: P
authors.lastname: Sobrino-Vegas
authors.affiliation: Department of Medicine, Autonomous University of Barcelona, Spain.
authors.forename: Pere
authors.initials: P
authors.lastname: Domingo
authors.affiliation: Medical University Innsbruck, Austria.
authors.forename: Robert
authors.initials: R
authors.lastname: Zangerle
authors.affiliation: Yale University School of Medicine, New Haven.|Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut.
authors.forename: Amy C
authors.initials: AC
authors.lastname: Justice
authors.affiliation: Vanderbilt University School of Medicine, Nashville, Tennessee.
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Sterling
authors.affiliation: Hospital Clinic-IDIBAPS, University of Barcelona, Spain.
authors.forename: José M
authors.initials: JM
authors.lastname: Miró
authors.affiliation: Schoolof Social and Community Medicine, University of Bristol, United Kingdom.
authors.forename: Jonathan A C
authors.initials: JAC
authors.lastname: Sterne
authors.forename: Andrew
authors.initials: A
authors.lastname: Boulle
authors.forename: Christoph
authors.initials: C
authors.lastname: Stephan
authors.forename: Jose M
authors.initials: JM
authors.lastname: Miro
authors.forename: Matthias
authors.initials: M
authors.lastname: Cavassini
authors.forename: Geneviève
authors.initials: G
authors.lastname: Chêne
authors.forename: Dominique
authors.initials: D
authors.lastname: Costagliola
authors.forename: François
authors.initials: F
authors.lastname: Dabis
authors.forename: Antonella D'Arminio
authors.initials: AD
authors.lastname: Monforte
authors.forename: Julia
authors.initials: J
authors.lastname: Del Amo
authors.forename: Ard
authors.initials: A
authors.lastname: Van Sighem
authors.forename: Gerd
authors.initials: G
authors.lastname: Fätkenheuer
authors.forename: John
authors.initials: J
authors.lastname: Gill
authors.forename: Jodie
authors.initials: J
authors.lastname: Guest
authors.forename: David Hans-Ulrich
authors.initials: DH
authors.lastname: Haerry
authors.forename: Robert
authors.initials: R
authors.lastname: Hogg
authors.forename: Amy
authors.initials: A
authors.lastname: Justice
authors.forename: Leah
authors.initials: L
authors.lastname: Shepherd
authors.forename: Neils
authors.initials: N
authors.lastname: Obel
authors.forename: Heidi
authors.initials: H
authors.lastname: Crane
authors.forename: Colette
authors.initials: C
authors.lastname: Smith
authors.forename: Peter
authors.initials: P
authors.lastname: Reiss
authors.forename: Michael
authors.initials: M
authors.lastname: Saag
authors.forename: Tim
authors.initials: T
authors.lastname: Sterling
authors.forename: Ramon
authors.initials: R
authors.lastname: Teira
authors.forename: Matthew
authors.initials: M
authors.lastname: Williams
authors.forename: Robert
authors.initials: R
authors.lastname: Zangerle
authors.forename: Jonathan
authors.initials: J
authors.lastname: Sterne
authors.forename: Margaret
authors.initials: M
authors.lastname: May
authors.forename: Suzanne
authors.initials: S
authors.lastname: Ingle
authors.forename: Adam
authors.initials: A
authors.lastname: Trickey
mesh_terms: D000293:Adolescent; D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology / Q000276:immunology* / Q000401:mortality*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents
keywords: CD4 count; HIV; antiretroviral therapy; cohort collaboration; mortality