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CD4 cell count and the risk of AIDS or death in HIV-Infected adults on combination antiretroviral therapy with a suppressed viral load: a longitudinal cohort study from COHERE.

Opportunistic Infections Project Team of the Collaboration of Ob, ; Young, J; Psichogiou, M; Meyer, L; Ayayi, S; Grabar, S; Raffi, F; Reiss, P; Gazzard, B; Sharland, M; et al. Opportunistic Infections Project Team of the Collaboration of Ob; Young, J; Psichogiou, M; Meyer, L; Ayayi, S; Grabar, S; Raffi, F; Reiss, P; Gazzard, B; Sharland, M; Gutierrez, F; Obel, N; Kirk, O; Miro, JM; Furrer, H; Castagna, A; De Wit, S; Muñoz, J; Kjaer, J; Grarup, J; Chêne, G; Bucher, H (2012) CD4 cell count and the risk of AIDS or death in HIV-Infected adults on combination antiretroviral therapy with a suppressed viral load: a longitudinal cohort study from COHERE. PLoS Medicine, 9 (3). e1001194. ISSN 1549-1676 https://doi.org/10.1371/journal.pmed.1001194
SGUL Authors: Sharland, Michael Roy

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Abstract

BACKGROUND: Most adults infected with HIV achieve viral suppression within a year of starting combination antiretroviral therapy (cART). It is important to understand the risk of AIDS events or death for patients with a suppressed viral load. METHODS AND FINDINGS: Using data from the Collaboration of Observational HIV Epidemiological Research Europe (2010 merger), we assessed the risk of a new AIDS-defining event or death in successfully treated patients. We accumulated episodes of viral suppression for each patient while on cART, each episode beginning with the second of two consecutive plasma viral load measurements <50 copies/µl and ending with either a measurement >500 copies/µl, the first of two consecutive measurements between 50-500 copies/µl, cART interruption or administrative censoring. We used stratified multivariate Cox models to estimate the association between time updated CD4 cell count and a new AIDS event or death or death alone. 75,336 patients contributed 104,265 suppression episodes and were suppressed while on cART for a median 2.7 years. The mortality rate was 4.8 per 1,000 years of viral suppression. A higher CD4 cell count was always associated with a reduced risk of a new AIDS event or death; with a hazard ratio per 100 cells/µl (95% CI) of: 0.35 (0.30-0.40) for counts <200 cells/µl, 0.81 (0.71-0.92) for counts 200 to <350 cells/µl, 0.74 (0.66-0.83) for counts 350 to <500 cells/µl, and 0.96 (0.92-0.99) for counts ≥500 cells/µl. A higher CD4 cell count became even more beneficial over time for patients with CD4 cell counts <200 cells/µl. CONCLUSIONS: Despite the low mortality rate, the risk of a new AIDS event or death follows a CD4 cell count gradient in patients with viral suppression. A higher CD4 cell count was associated with the greatest benefit for patients with a CD4 cell count <200 cells/µl but still some slight benefit for those with a CD4 cell count ≥500 cells/µl.

Item Type: Article
Additional Information: PMCID: PMC3308938 ©2012 Collaboration of Observational HIV Epidemiological Research in Europe (COHERE). This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Keywords: Acquired Immunodeficiency Syndrome, Adult, Anti-Retroviral Agents, CD4 Lymphocyte Count, Cohort Studies, Drug Therapy, Combination, Female, HIV Infections, Humans, Longitudinal Studies, Male, Viral Load
SGUL Research Institute / Research Centre: Academic Structure > Infection and Immunity Research Institute (INII)
Journal or Publication Title: PLoS Medicine
ISSN: 1549-1676
Dates:
DateEvent
20 March 2012Published
PubMed ID: 22448150
Web of Science ID: 22448150
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URI: http://sgultest.da.ulcc.ac.uk/id/eprint/101222
Publisher's version: https://doi.org/10.1371/journal.pmed.1001194

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