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A CD4+ cell count <200 cells per cubic millimeter at 2 years after initiation of combination antiretroviral therapy is associated with increased mortality in HIV-infected individuals with viral suppression
journal contribution
posted on 2023-06-08, 16:42 authored by Mona R Loutfy, Miguel Genebat, David Moore, Janet Raboud, Keith Chan, Tony Antoniou, David Milan, Anya Shen, Marina B Klein, Curtis Cooper, Nima Machouf, Sean B Rourke, Anita Rachlis, Chris Tsoukas, Julio S G Montaner, Sharon L Walmsley, Marek Smieja, Ahmed Bayoumi, Edward Mills, Robert S Hogg, The CANOC Collaboration, Martin FisherOBJECTIVE To determine the long-term impact of immunologic discordance (viral load <50 copies/mL and CD4+ count <=200 cells/mm3) in antiretroviral-naive patients initiating combination antiretroviral therapy (cART). METHODS Our analysis included antiretroviral-naive individuals from a population-based Canadian Observational Cohort that initiated cART after January 1, 2000, and achieved virologic suppression. Multivariable Cox proportional hazards regression was used to examine the association between 1-year and 2-year immunologic discordance and time to death from all-causes. Correlates of immunologic discordance were assessed with logistic regression. RESULTS Immunologic discordance was observed in 19.9% (404 of 2028) and 10.2% (176 of 1721) of individuals at 1 and 2 years after cART initiation, respectively. Two-year immunologic discordance was associated with an increased risk of death [adjusted hazard ratio = 2.69; 95% confidence interval (CI): 1.26 to 5.78]. One-year immunologic discordance was not associated with death (adjusted hazard ratio = 1.12; 95% CI: 0.54 to 2.30). Two-year immunologic discordance was associated with older age (aOR per decade = 1.23; 95% CI: 1.03 to 1.48), male gender (aOR = 1.86; 95% CI: 1.09 to 3.16), injection drug use (aOR = 2.75; 95% CI: 1.81 to 4.17), and lower baseline CD4+ count (aOR per 100 cells = 0.24; 95% CI: 0.19 to 0.31) and viral load (aOR per log10 copies/mL = 0.46; 95% CI: 0.33 to 0.65). CONCLUSIONS Immunologic discordance after 2 years of cART in antiretroviral-naive individuals was significantly associated with an increased risk of mortality.
History
Publication status
- Published
Journal
Journal of Acquired Immune Deficiency SyndromesISSN
1525-4135Publisher
Lippincott, Williams & WilkinsExternal DOI
Issue
4Volume
55Page range
451-459Department affiliated with
- BSMS Publications
Notes
Martin Fisher is not a named author of this article but is a member of the CANOC Collaboration.Full text available
- No
Peer reviewed?
- Yes
Legacy Posted Date
2014-03-31Usage metrics
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