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 K.
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, L. P.
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 - 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.
AU - Schreij, G.
AU - Bravenboer, B.
AU - Anastos, K.
N1 - Funding Information:
ATHENA The ATHENA database is supported by a grant from the Dutch Health Minister and was set up and is maintained by the Stichting HIV Monitoring. CoRIS and CoRIS-MD Supported by Red de Investigación en SIDA ( ISCIII-RETIC-RD06/0006 ). EuroSIDA Primary support for EuroSIDA is provided by the European Commission BIOMED 1 (CT94-1637), BIOMED 2 (CT97-2713) , the 5th Framework ( QLK2-2000-00773 ) and the 6th Framework ( LSHP-CT-2006-018632 ) programmes. Current support also includes unrestricted grants by Gilead, Pfizer, and Merck and Co. The participation of centres from Switzerland was supported by a grant from the Swiss Federal Office for Education and Science. ICONA The Icona Foundation Study is supported by unrestricted educational grants from Abbott, Boehringer Ingelheim, Bristol-Myers Squibb, Gilead, GlaxoSmithKline, Pfizer and Janssen-Cilag. KOMPNET The German Competence Network for HIV/AIDS is supported by the Federal Ministry of Education and Research ( FK01KI0501 ) and the Ruhr-Universität Bochum. MACS Funded by the National Institute of Allergy and Infectious Diseases, with additional supplemental funding from the National Cancer Institute . UO1-AI-35042, 5-MO1-RR-00052 (GCRC), UO1-AI-35043, UO1-AI-35039, UO1-AI-35040, UO1-AI-35041 . Website located at http://www.statepi.jhsph.edu/macs/macs.html . Montreal Chest Immunodeficiency Cohort Founded by Richard Lalonde and has received infrastructure funding from the Fonds de recherche en santé du Québec, Réseau SIDA/maladies infectieuses (FRSQ). Marina Klein is supported by a Chercheur-Boursier clinicien senior career award from the FRSQ. PISCIS Supported by the Fundación para la Investigación y la Prevención del SIDA en España (FIPSE), the Catalan Health Department (Generalitat de Catalunya), and the Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP). Swiss HIV Cohort Study Supported by the Swiss National Science Foundation. UK CHIC Funded by the Medical Research Council, UK. WIHS Funded by the National Institutes of Health.
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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U2 - 10.1016/S0140-6736(10)60932-4
DO - 10.1016/S0140-6736(10)60932-4
M3 - Article
C2 - 20638118
AN - SCOPUS:77955716641
SN - 0140-6736
VL - 376
SP - 340
EP - 345
JO - The Lancet
JF - The Lancet
IS - 9738
ER -