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.

<h4>Background</h4>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.<h4>Methods and findings</h4&g...

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Autores principales:	Opportunistic Infections Project Team of the Collaboration of Observational HIV Epidemiological Research in Europe (COHERE) in EuroCoord, Jim Young, Mina Psichogiou, Laurence Meyer, Sylvie Ayayi, Sophie Grabar, Francois Raffi, Peter Reiss, Brian Gazzard, Mike Sharland, Félix Gutierrez, Niels Obel, Ole Kirk, José M Miro, Hansjakob Furrer, Antonella Castagna, Stéphane De Wit, Josefa Muñoz, Jesper Kjaer, Jesper Grarup, Geneviève Chêne, Heiner Bucher
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2012
Materias:	Medicine R
Acceso en línea:	https://doaj.org/article/24982624540344a1a86d373ca8d83720
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spelling	oai:doaj.org-article:24982624540344a1a86d373ca8d837202021-11-18T05:42:19ZCD4 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.1549-12771549-167610.1371/journal.pmed.1001194https://doaj.org/article/24982624540344a1a86d373ca8d837202012-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/22448150/pdf/?tool=EBIhttps://doaj.org/toc/1549-1277https://doaj.org/toc/1549-1676<h4>Background</h4>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.<h4>Methods and findings</h4>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.<h4>Conclusions</h4>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.Opportunistic Infections Project Team of the Collaboration of Observational HIV Epidemiological Research in Europe (COHERE) in EuroCoordJim YoungMina PsichogiouLaurence MeyerSylvie AyayiSophie GrabarFrancois RaffiPeter ReissBrian GazzardMike SharlandFélix GutierrezNiels ObelOle KirkJosé M MiroHansjakob FurrerAntonella CastagnaStéphane De WitJosefa MuñozJesper KjaerJesper GrarupGeneviève ChêneHeiner BucherPublic Library of Science (PLoS)articleMedicineRENPLoS Medicine, Vol 9, Iss 3, p e1001194 (2012)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R
spellingShingle	Medicine R Opportunistic Infections Project Team of the Collaboration of Observational HIV Epidemiological Research in Europe (COHERE) in EuroCoord Jim Young Mina Psichogiou Laurence Meyer Sylvie Ayayi Sophie Grabar Francois Raffi Peter Reiss Brian Gazzard Mike Sharland Félix Gutierrez Niels Obel Ole Kirk José M Miro Hansjakob Furrer Antonella Castagna Stéphane De Wit Josefa Muñoz Jesper Kjaer Jesper Grarup Geneviève Chêne Heiner Bucher 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.
description	<h4>Background</h4>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.<h4>Methods and findings</h4>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.<h4>Conclusions</h4>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.
format	article
author	Opportunistic Infections Project Team of the Collaboration of Observational HIV Epidemiological Research in Europe (COHERE) in EuroCoord Jim Young Mina Psichogiou Laurence Meyer Sylvie Ayayi Sophie Grabar Francois Raffi Peter Reiss Brian Gazzard Mike Sharland Félix Gutierrez Niels Obel Ole Kirk José M Miro Hansjakob Furrer Antonella Castagna Stéphane De Wit Josefa Muñoz Jesper Kjaer Jesper Grarup Geneviève Chêne Heiner Bucher
author_facet	Opportunistic Infections Project Team of the Collaboration of Observational HIV Epidemiological Research in Europe (COHERE) in EuroCoord Jim Young Mina Psichogiou Laurence Meyer Sylvie Ayayi Sophie Grabar Francois Raffi Peter Reiss Brian Gazzard Mike Sharland Félix Gutierrez Niels Obel Ole Kirk José M Miro Hansjakob Furrer Antonella Castagna Stéphane De Wit Josefa Muñoz Jesper Kjaer Jesper Grarup Geneviève Chêne Heiner Bucher
author_sort	Opportunistic Infections Project Team of the Collaboration of Observational HIV Epidemiological Research in Europe (COHERE) in EuroCoord
title	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.
title_short	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.
title_full	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.
title_fullStr	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.
title_full_unstemmed	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.
title_sort	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.
publisher	Public Library of Science (PLoS)
publishDate	2012
url	https://doaj.org/article/24982624540344a1a86d373ca8d83720
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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.

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