Death rates in HIV-positive antiretroviral-naive patients with CD4 count greater than 350 cells per μl in Europe and North America

A pooled cohort observational study

AMACS Steering committee, CASCADE Steering committee, CoRIS and CoRIS-MD Steering committee, Danish HIV Cohort Study Steering commitee and members, Steering committee, IDD-HSR Representative of the cohort, Scientifi c commmittee, KOMPNET Steering committee, PISCIS Coordinators, Scientifi c committee, Swiss HIV Cohort Study, Medical Research Council Clinical Trials Unit (MRC CTU)

Research output: Contribution to journalArticle

70 Citations (Scopus)

Abstract

Summary Background Whether people living with HIV who have not received antiretroviral therapy (ART) and have high CD4 cell counts have higher mortality than the general population is unknown. We aimed to examine this by analysis of pooled data from industrialised countries. We merged data on demographics, CD4 cell counts, viral-load measurements, hepatitis C co-infection status, smoking status, date of death, and whether death was AIDS-related or not from 23 European and North American cohorts. We calculated standardised mortality ratios (SMRs) standardised by age, sex, and year, stratifying by risk group. Data were included for patients aged 20-59 years who had at least one CD4 count greater than 350 cells per μL while ART naive. All pre-ART CD4 counts greater than 350 cells per μL from January, 1990, to December, 2004, were included. We investigated mortality for four risk groups - men who have sex with men, heterosexual people, injecting drug users, and those at other or unknown risk. The association between CD4 cell count and death rate was investigated by use of Poisson regression methods. Data were analysed for 40 830 patients contributing 80 682 person-years of follow-up. Of 419 deaths, 401 were used in the SMR analysis: 100 men who have sex with men (SMR 1·30, 95 CI 1·06-1·58); 68 heterosexual people (2·94, 2·28-3·73); 203 injecting drug users (9·37, 8·13-10·75); and 30 in the other or unknown risk category (4·57, 3·09-6·53). Compared with CD4 counts of 350-499 cells per μL, death rate was lower in patients with counts of 500-699 cells per μL (adjusted rate ratio 0·77, 95 CI 0·61-0·95) and counts of 700 cells per μL (0·66, 0·52-0·85). In HIV-infected ART-naive patients with high CD4 cell counts, death rates were raised compared with the general population. In men who have sex with men this was modest, suggesting that a substantial proportion of the increased risk in other groups is due to confounding by other factors. Even though the increased risk is small, new studies of potential benefits of ART in this group are merited. European Commission, FP6. European AIDS Treatment Network (NEAT). Project number LSHP-CT-2006-037570.

Original languageEnglish (US)
Pages (from-to)340-345
Number of pages6
JournalThe Lancet
Volume376
Issue number9738
DOIs
StatePublished - Jul 31 2010
Externally publishedYes

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CD4 Lymphocyte Count
North America
Observational Studies
Cohort Studies
HIV
Mortality
Heterosexuality
Drug Users
Acquired Immunodeficiency Syndrome
Cell Death
Therapeutics
Hepatitis C
Group Psychotherapy
Viral Load
Coinfection
Developed Countries
Population
Cell Count
Smoking
Demography

ASJC Scopus subject areas

  • Medicine(all)

Cite this

AMACS Steering committee, CASCADE Steering committee, CoRIS and CoRIS-MD Steering committee, Danish HIV Cohort Study Steering commitee and members, Steering committee, IDD-HSR Representative of the cohort, ... Medical Research Council Clinical Trials Unit (MRC CTU) (2010). Death rates in HIV-positive antiretroviral-naive patients with CD4 count greater than 350 cells per μl in Europe and North America: A pooled cohort observational study. The Lancet, 376(9738), 340-345. https://doi.org/10.1016/S0140-6736(10)60932-4

Death rates in HIV-positive antiretroviral-naive patients with CD4 count greater than 350 cells per μl in Europe and North America : A pooled cohort observational study. / AMACS Steering committee; CASCADE Steering committee; CoRIS and CoRIS-MD Steering committee; Danish HIV Cohort Study Steering commitee and members; Steering committee; IDD-HSR Representative of the cohort; Scientifi c commmittee; KOMPNET Steering committee; PISCIS Coordinators; Scientifi c committee; Swiss HIV Cohort Study; Medical Research Council Clinical Trials Unit (MRC CTU).

In: The Lancet, Vol. 376, No. 9738, 31.07.2010, p. 340-345.

Research output: Contribution to journalArticle

AMACS Steering committee, CASCADE Steering committee, CoRIS and CoRIS-MD Steering committee, Danish HIV Cohort Study Steering commitee and members, Steering committee, IDD-HSR Representative of the cohort, Scientifi c commmittee, KOMPNET Steering committee, PISCIS Coordinators, Scientifi c committee, Swiss HIV Cohort Study & Medical Research Council Clinical Trials Unit (MRC CTU) 2010, 'Death rates in HIV-positive antiretroviral-naive patients with CD4 count greater than 350 cells per μl in Europe and North America: A pooled cohort observational study', The Lancet, vol. 376, no. 9738, pp. 340-345. https://doi.org/10.1016/S0140-6736(10)60932-4
AMACS Steering committee, CASCADE Steering committee, CoRIS and CoRIS-MD Steering committee, Danish HIV Cohort Study Steering commitee and members, Steering committee, IDD-HSR Representative of the cohort et al. Death rates in HIV-positive antiretroviral-naive patients with CD4 count greater than 350 cells per μl in Europe and North America: A pooled cohort observational study. The Lancet. 2010 Jul 31;376(9738):340-345. https://doi.org/10.1016/S0140-6736(10)60932-4
AMACS Steering committee ; CASCADE Steering committee ; CoRIS and CoRIS-MD Steering committee ; Danish HIV Cohort Study Steering commitee and members ; Steering committee ; IDD-HSR Representative of the cohort ; Scientifi c commmittee ; KOMPNET Steering committee ; PISCIS Coordinators ; Scientifi c committee ; Swiss HIV Cohort Study ; Medical Research Council Clinical Trials Unit (MRC CTU). / Death rates in HIV-positive antiretroviral-naive patients with CD4 count greater than 350 cells per μl in Europe and North America : A pooled cohort observational study. In: The Lancet. 2010 ; Vol. 376, No. 9738. pp. 340-345.
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abstract = "Summary Background Whether people living with HIV who have not received antiretroviral therapy (ART) and have high CD4 cell counts have higher mortality than the general population is unknown. We aimed to examine this by analysis of pooled data from industrialised countries. We merged data on demographics, CD4 cell counts, viral-load measurements, hepatitis C co-infection status, smoking status, date of death, and whether death was AIDS-related or not from 23 European and North American cohorts. We calculated standardised mortality ratios (SMRs) standardised by age, sex, and year, stratifying by risk group. Data were included for patients aged 20-59 years who had at least one CD4 count greater than 350 cells per μL while ART naive. All pre-ART CD4 counts greater than 350 cells per μL from January, 1990, to December, 2004, were included. We investigated mortality for four risk groups - men who have sex with men, heterosexual people, injecting drug users, and those at other or unknown risk. The association between CD4 cell count and death rate was investigated by use of Poisson regression methods. Data were analysed for 40 830 patients contributing 80 682 person-years of follow-up. Of 419 deaths, 401 were used in the SMR analysis: 100 men who have sex with men (SMR 1·30, 95 CI 1·06-1·58); 68 heterosexual people (2·94, 2·28-3·73); 203 injecting drug users (9·37, 8·13-10·75); and 30 in the other or unknown risk category (4·57, 3·09-6·53). Compared with CD4 counts of 350-499 cells per μL, death rate was lower in patients with counts of 500-699 cells per μL (adjusted rate ratio 0·77, 95 CI 0·61-0·95) and counts of 700 cells per μL (0·66, 0·52-0·85). In HIV-infected ART-naive patients with high CD4 cell counts, death rates were raised compared with the general population. In men who have sex with men this was modest, suggesting that a substantial proportion of the increased risk in other groups is due to confounding by other factors. Even though the increased risk is small, new studies of potential benefits of ART in this group are merited. European Commission, FP6. European AIDS Treatment Network (NEAT). Project number LSHP-CT-2006-037570.",
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TY - JOUR

T1 - Death rates in HIV-positive antiretroviral-naive patients with CD4 count greater than 350 cells per μl in Europe and North America

T2 - A pooled cohort observational study

AU - AMACS Steering committee

AU - CASCADE Steering committee

AU - CoRIS and CoRIS-MD Steering committee

AU - Danish HIV Cohort Study Steering commitee and members

AU - Steering committee

AU - IDD-HSR Representative of the cohort

AU - Scientifi c commmittee

AU - KOMPNET Steering committee

AU - PISCIS Coordinators

AU - Scientifi c committee

AU - Swiss HIV Cohort Study

AU - Medical Research Council Clinical Trials Unit (MRC CTU)

AU - Lodwick, Rebecca

AU - Sabin, Caroline A.

AU - Porter, Kholoud

AU - Ledergerber, Bruno

AU - Van Sighem, Ard

AU - Cozzi-Lepri, Alessandro

AU - Khaykin, Pavel

AU - Mocroft, Amanda

AU - Jacobson, Lisa

AU - De Wit, Stephane

AU - Obel, Niels

AU - Castagna, Antonella

AU - Wasmuth, Jan Christian

AU - Gill, John

AU - Klein, Marina B.

AU - Gange, Stephen

AU - Riera, Melchor

AU - Mussini, Cristina

AU - Gutiérrez, Félix

AU - Touloumi, Giota

AU - Carrieri, Patrizia

AU - Guest, Jodie L.

AU - Brockmeyer, Norbert H.

AU - Phillips, Andrew N.

AU - Antoniadou, A.

AU - Gargalianos-Kakolyris, P.

AU - Katsarou, O.

AU - Kordossis, T.

AU - Lazanas, M.

AU - Panos, G.

AU - Paparizos, V.

AU - Paraskevis, D.

AU - Petrikkos, G.

AU - Sambatakou, H.

AU - Skoutelis, A.

AU - Touloumi, G.

AU - Bakoyannis, Giorgos

AU - Paraskevis, D.

AU - Pantazis, N.

AU - Bakoyannis, G.

AU - Gioukari, V.

AU - de Wolf, F.

AU - O Bezemer, D.

AU - Gras, L. A.J.

AU - Kesselring, A. M.

AU - van Sighem, A. I.

AU - Smit, C.

AU - Zhang, S.

AU - Zaheri, S.

AU - Prins, J. M.

PY - 2010/7/31

Y1 - 2010/7/31

N2 - Summary Background Whether people living with HIV who have not received antiretroviral therapy (ART) and have high CD4 cell counts have higher mortality than the general population is unknown. We aimed to examine this by analysis of pooled data from industrialised countries. We merged data on demographics, CD4 cell counts, viral-load measurements, hepatitis C co-infection status, smoking status, date of death, and whether death was AIDS-related or not from 23 European and North American cohorts. We calculated standardised mortality ratios (SMRs) standardised by age, sex, and year, stratifying by risk group. Data were included for patients aged 20-59 years who had at least one CD4 count greater than 350 cells per μL while ART naive. All pre-ART CD4 counts greater than 350 cells per μL from January, 1990, to December, 2004, were included. We investigated mortality for four risk groups - men who have sex with men, heterosexual people, injecting drug users, and those at other or unknown risk. The association between CD4 cell count and death rate was investigated by use of Poisson regression methods. Data were analysed for 40 830 patients contributing 80 682 person-years of follow-up. Of 419 deaths, 401 were used in the SMR analysis: 100 men who have sex with men (SMR 1·30, 95 CI 1·06-1·58); 68 heterosexual people (2·94, 2·28-3·73); 203 injecting drug users (9·37, 8·13-10·75); and 30 in the other or unknown risk category (4·57, 3·09-6·53). Compared with CD4 counts of 350-499 cells per μL, death rate was lower in patients with counts of 500-699 cells per μL (adjusted rate ratio 0·77, 95 CI 0·61-0·95) and counts of 700 cells per μL (0·66, 0·52-0·85). In HIV-infected ART-naive patients with high CD4 cell counts, death rates were raised compared with the general population. In men who have sex with men this was modest, suggesting that a substantial proportion of the increased risk in other groups is due to confounding by other factors. Even though the increased risk is small, new studies of potential benefits of ART in this group are merited. European Commission, FP6. European AIDS Treatment Network (NEAT). Project number LSHP-CT-2006-037570.

AB - Summary Background Whether people living with HIV who have not received antiretroviral therapy (ART) and have high CD4 cell counts have higher mortality than the general population is unknown. We aimed to examine this by analysis of pooled data from industrialised countries. We merged data on demographics, CD4 cell counts, viral-load measurements, hepatitis C co-infection status, smoking status, date of death, and whether death was AIDS-related or not from 23 European and North American cohorts. We calculated standardised mortality ratios (SMRs) standardised by age, sex, and year, stratifying by risk group. Data were included for patients aged 20-59 years who had at least one CD4 count greater than 350 cells per μL while ART naive. All pre-ART CD4 counts greater than 350 cells per μL from January, 1990, to December, 2004, were included. We investigated mortality for four risk groups - men who have sex with men, heterosexual people, injecting drug users, and those at other or unknown risk. The association between CD4 cell count and death rate was investigated by use of Poisson regression methods. Data were analysed for 40 830 patients contributing 80 682 person-years of follow-up. Of 419 deaths, 401 were used in the SMR analysis: 100 men who have sex with men (SMR 1·30, 95 CI 1·06-1·58); 68 heterosexual people (2·94, 2·28-3·73); 203 injecting drug users (9·37, 8·13-10·75); and 30 in the other or unknown risk category (4·57, 3·09-6·53). Compared with CD4 counts of 350-499 cells per μL, death rate was lower in patients with counts of 500-699 cells per μL (adjusted rate ratio 0·77, 95 CI 0·61-0·95) and counts of 700 cells per μL (0·66, 0·52-0·85). In HIV-infected ART-naive patients with high CD4 cell counts, death rates were raised compared with the general population. In men who have sex with men this was modest, suggesting that a substantial proportion of the increased risk in other groups is due to confounding by other factors. Even though the increased risk is small, new studies of potential benefits of ART in this group are merited. European Commission, FP6. European AIDS Treatment Network (NEAT). Project number LSHP-CT-2006-037570.

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JO - The Lancet

JF - The Lancet

SN - 0140-6736

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