1. Long-term mortality in HIV-positive individuals virally suppressed for >3 years with incomplete CD4 recovery
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Engsig, F. N., Zangerle, R., Katsarou, O., Dabis, F., Reiss, P., Gill, J., Porter, K., Sabin, C., Riordan, A., Fatkenheuer, G., Gutierrez, F., Raffi, F., Kirk, O., Mary-Krause, M., Stephan, C., de Olalla, P. G., Guest, J., Samji, H., Castagna, A., d'Arminio Monforte, A., Skaletz-Rorowski, A., Ramos, J., Lapadula, G., Mussini, C., Force, L., Meyer, L., Lampe, F., Boufassa, F., Bucher, H. C., De Wit, S., Burkholder, G. A., Teira, R., Justice, A. C., Sterling, T. R., M. Crane, H., Gerstoft, J., Grarup, J., May, M., Chene, G., Ingle, S. M., Sterne, J., Obel, N., Burkholder, G., Justice, A., R Sterling, T., Crane, H. M., Boulle, A., Brodt, H.-R., Casabona, J., Cavassini, M., Costagliola, D., D'Arminio Monforte, A., del Amo, J., Van Sighem, A., Hans-Ulrich Haerry, D., Hogg, R., Mocroft, A., Kitahata, M., Saag, M., Williams, M., Ingle, S., Touloumi, G., Warszawski, J., Krause, M. M., Ghosn, J., Leport, C., Wit, F., Prins, M., Gibb, D., Del Amo, J., Thorne, C., Perez-Hoyos, S., Hamouda, O., Gussenheimer-Bartmeyer, B., Noguera-Julian, A., Antinori, A., Brockmeyer, N., Battegay, M., Rauch, A., Tookey, P., Miro, J. M., de Wit, S., Goetghebuer, T., Torti, C., Garrido, M., Judd, A., Conejo, P. R., Haerry, D., Weller, I., d'Arminio-Monforte, A., Colin, C., Schwimmer, C., Termote, M., Kjaer, J., Campbell, M., Raben, D., Bohlius, J., Bouteloup, V., Bucher, H., Cozzi-Lepri, A., Dorrucci, M., Egger, M., Engsig, F., Furrer, H., Lambotte, O., Lewden, C., Lodi, S., Lodwick, R., Matheron, S., Miro, J., Monge, S., Nakagawa, F., Paredes, R., Phillips, A., Puoti, M., Reekie, J., Scherrer, A., Smit, C., Thiebaut, R., Wittkop, L., 2nd Blood Transfusion Center and Hemophilia Center, 'Laiko' General Hospital, Epidémiologie et Biostatistique [Bordeaux], Université Bordeaux Segalen - Bordeaux 2-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), Structures et propriétés d'architectures moléculaire (SPRAM - UMR 5819), Institut Nanosciences et Cryogénie (INAC), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Université Grenoble Alpes (UGA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Université Grenoble Alpes (UGA)-Centre National de la Recherche Scientifique (CNRS), Observatoire des Micro et Nano Technologies (OMNT - UMS 2920), Laboratoire d'Electronique et des Technologies de l'Information (CEA-LETI), Direction de Recherche Technologique (CEA) (DRT (CEA)), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Université Grenoble Alpes (UGA)-Direction de Recherche Technologique (CEA) (DRT (CEA)), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Université Grenoble Alpes (UGA)-Centre National de la Recherche Scientifique (CNRS), Southern Alberta Clinic, Research Department of Infection and Population Health [London], University College of London [London] (UCL), Equipe Perception et design sonores, Sciences et Technologies de la Musique et du Son (STMS), Université Pierre et Marie Curie - Paris 6 (UPMC)-IRCAM-Centre National de la Recherche Scientifique (CNRS)-Université Pierre et Marie Curie - Paris 6 (UPMC)-IRCAM-Centre National de la Recherche Scientifique (CNRS), Equipe Interactions musicales temps-réel, Maladies infectieuses et tropicales, Université Pierre et Marie Curie - Paris 6 (UPMC), Institute of Biology, Neuchatel, Université de Neuchâtel (UNINE), School of Psychology, St Andrews, University of St Andrews [Scotland], Infectious Diseases, San Raffaele Scientific Institute, EA 4100, Histoire culturelle et sociale de l'art (HiCSA), Université Panthéon-Sorbonne (UP1)-Université Panthéon-Sorbonne (UP1), Laboratory of Inorganic Chemistry, Eidgenössische Technische Hochschule - Swiss Federal Institute of Technology in Zürich [Zürich] (ETH Zürich), Princeton University, Immuno-Rhumatologie Moléculaire, Université de Strasbourg (UNISTRA)-Institut National de la Santé et de la Recherche Médicale (INSERM), Population Sciences, Centre de recherche en épidémiologie et santé des populations (CESP), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM), Paläontologisches Institut und Museum, Universität Zürich [Zürich] (UZH), Laboratory, GD Deventer, Rigshospitalet [Copenhagen], Department of Social Medicine, University of Bristol [Bristol], Department of Infectious Diseases, Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019])-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019])-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS), Commissariat à l'énergie atomique et aux énergies alternatives - Laboratoire d'Electronique et de Technologie de l'Information (CEA-LETI), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Direction de Recherche Technologique (CEA) (DRT (CEA)), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Centre National de la Recherche Scientifique (CNRS), Institut de Recherche et Coordination Acoustique/Musique (IRCAM)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche et Coordination Acoustique/Musique (IRCAM)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Centre National de la Recherche Scientifique (CNRS), School of Psychology and Neuroscience [University of St. Andrews], Université Paris 1 Panthéon-Sorbonne (UP1)-Université Paris 1 Panthéon-Sorbonne (UP1), Eidgenössische Technische Hochschule - Swiss Federal Institute of Technology [Zürich] (ETH Zürich), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM), Universität Zürich [Zürich] = University of Zurich (UZH), Royal GD [Deventer], Copenhagen University Hospital, Copenhagen University Hospital-Copenhagen University Hospital, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris-Sud - Paris 11 (UP11)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Engsig, F. N., Zangerle, R., Katsarou, O., Dabis, F., Reiss, P., Gill, J., Porter, K., Sabin, C., Riordan, A., Fatkenheuer, G., Gutierrez, F., Raffi, F., Kirk, O., Mary-Krause, M., Stephan, C., De Olalla, P. G., Guest, J., Samji, H., Castagna, A., D'arminio Monforte, A., Skaletz-Rorowski, A., Ramos, J., Lapadula, G., Mussini, C., Force, L., Meyer, L., Lampe, F., Boufassa, F., Bucher, H. C., De Wit, S., Burkholder, G. A., Teira, R., Justice, A. C., Sterling, T. R., M. Crane, H., Gerstoft, J., Grarup, J., May, M., Chene, G., Ingle, S. M., Sterne, J., Obel, N., Engsig, F, Zangerle, R, Katsarou, O, Dabis, F, Reiss, P, Gill, J, Porter, K, Sabin, C, Riordan, A, Fatkenheuer, G, Gutierrez, F, Raffi, F, Kirk, O, Mary-Krause, M, Stephan, C, De Olalla, P, Guest, J, Samji, H, Castagna, A, D'arminio Monforte, A, Skaletz-Rorowski, A, Ramos, J, Lapadula, G, Mussini, C, Force, L, Meyer, L, Lampe, F, Boufassa, F, Bucher, H, De Wit, S, Burkholder, G, Teira, R, Justice, A, Sterling, T, M. Crane, H, Gerstoft, J, Grarup, J, May, M, Chene, G, Ingle, S, Sterne, J, Obel, N, AII - Amsterdam institute for Infection and Immunity, APH - Amsterdam Public Health, Global Health, and Infectious diseases
- Subjects
Male ,Oncology ,MESH: CD4 Lymphocyte Count ,[SDV]Life Sciences [q-bio] ,HIV Infections ,MESH: Logistic Models ,Cohort Studies ,MESH: Cause of Death ,0302 clinical medicine ,Risk Factors ,MESH: Risk Factors ,Cause of Death ,Medicine ,HIV Infection ,030212 general & internal medicine ,MESH: Anti-HIV Agents ,MESH: Cohort Studies ,Immunodeficiency ,Cause of death ,0303 health sciences ,MESH: Middle Aged ,Hazard ratio ,MESH: HIV Infections ,Middle Aged ,Viral Load ,3. Good health ,Infectious Diseases ,MESH: Substance-Related Disorders ,HIV/AIDS ,Female ,MESH: Viral Load ,Viral load ,MESH: Heterosexuality ,Human ,Adult ,Microbiology (medical) ,Cart ,medicine.medical_specialty ,Logistic Model ,Anti-HIV Agents ,Substance-Related Disorders ,03 medical and health sciences ,Acquired immunodeficiency syndrome (AIDS) ,Internal medicine ,Humans ,sustained viral suppression ,Heterosexuality ,030304 developmental biology ,MESH: Humans ,business.industry ,Proportional hazards model ,Risk Factor ,Anti-HIV Agent ,HIV ,MESH: Adult ,Substance-Related Disorder ,medicine.disease ,mortality ,CD4 cell recovery ,Confidence interval ,MESH: Male ,CD4 Lymphocyte Count ,Logistic Models ,Immunology ,[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie ,Cohort Studie ,business ,MESH: Female - Abstract
Background. Some human immunodeficiency virus (HIV)-infected individuals initiating combination antiretroviral therapy (cART) with low CD4 counts achieve viral suppression but not CD4 cell recovery. We aimed to identify (1) risk factors for failure to achieve CD4 count >200 cells/μL after 3 years of sustained viral suppression and (2) the association of the achieved CD4 count with subsequent mortality.Methods. We included treated HIV-infected adults from 2 large international HIV cohorts, who had viral suppression (≤500 HIV type 1 RNA copies/mL) for >3 years with CD4 count ≤200 cells/μL at start of the suppressed period. Logistic regression was used to identify risk factors for incomplete CD4 recovery (≤200 cells/μL) and Cox regression to identify associations with mortality.Results. Of 5550 eligible individuals, 835 (15%) did not reach a CD4 count >200 cells/μL after 3 years of suppression. Increasing age, lower initial CD4 count, male heterosexual and injection drug use transmission, cART initiation after 1998, and longer time from initiation of cART to start of the virally suppressed period were risk factors for not achieving a CD4 count >200 cells/μL. Individuals with CD4 ≤200 cells/μL after 3 years of viral suppression had substantially increased mortality (adjusted hazard ratio, 2.60; 95% confidence interval, 1.86-3.61) compared with those who achieved CD4 count >200 cells/μL. The increased mortality was seen across different patient groups and for all causes of death.Conclusions. Virally suppressed HIV-positive individuals on cART who do not achieve a CD4 count >200 cells/μL have substantially increased long-term mortality. © The Author 2014.
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- 2014