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.

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 / Lewden, C; Bouteloup, V; De Wit, S; Sabin, C; Mocroft, A; Wasmuth, Jc; van Sighem, A; Kirk, O; Obel, N; Panos, G; Ghosn, J; Dabis, F; Mary Krause, M; Leport, C; Perez Hoyos, S; Sobrino Vegas, P; Stephan, C; Castagna, A; Antinori, A; d'Arminio Monforte, A; Torti, C; Mussini, Cristina; Isern, V; Calmy, A; Teira, R; Egger, M; Grarup, J; Chêne, G; Collaboration of Observational HIV Epidemiological Research Europe in, Eurocoord. - In: INTERNATIONAL JOURNAL OF EPIDEMIOLOGY. - ISSN 0300-5771. - STAMPA. - 41:2(2012), pp. 433-445. [10.1093/ije/dyr164]

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.

MUSSINI, Cristina;
2012

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.
2012
41
2
433
445
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 / Lewden, C; Bouteloup, V; De Wit, S; Sabin, C; Mocroft, A; Wasmuth, Jc; van Sighem, A; Kirk, O; Obel, N; Panos, G; Ghosn, J; Dabis, F; Mary Krause, M; Leport, C; Perez Hoyos, S; Sobrino Vegas, P; Stephan, C; Castagna, A; Antinori, A; d'Arminio Monforte, A; Torti, C; Mussini, Cristina; Isern, V; Calmy, A; Teira, R; Egger, M; Grarup, J; Chêne, G; Collaboration of Observational HIV Epidemiological Research Europe in, Eurocoord. - In: INTERNATIONAL JOURNAL OF EPIDEMIOLOGY. - ISSN 0300-5771. - STAMPA. - 41:2(2012), pp. 433-445. [10.1093/ije/dyr164]
Lewden, C; Bouteloup, V; De Wit, S; Sabin, C; Mocroft, A; Wasmuth, Jc; van Sighem, A; Kirk, O; Obel, N; Panos, G; Ghosn, J; Dabis, F; Mary Krause, M; Leport, C; Perez Hoyos, S; Sobrino Vegas, P; Stephan, C; Castagna, A; Antinori, A; d'Arminio Monforte, A; Torti, C; Mussini, Cristina; Isern, V; Calmy, A; Teira, R; Egger, M; Grarup, J; Chêne, G; Collaboration of Observational HIV Epidemiological Research Europe in, Eurocoord
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