Cause-specific mortality among HIV-infected individuals, by CD4(+) cell count at HAART initiation, compared with HIV-uninfected individuals.

Abstract

OBJECTIVES:

To compare the proportion, timing and hazards of non-AIDS death and AIDS death among men and women who initiated HAART at different CD4 cell counts to mortality risks of HIV-uninfected persons with similar risk factors.

DESIGN:

Prospective cohort studies.

METHODS:

We used parametric mixture models to compare proportions of AIDS and non-AIDS mortality and ages at death, and multivariable Cox models to compare cause-specific hazards of mortality, across levels of CD4 cell count at HAART initiation (≤200 cells/μl: 'late', 201-350 cells/μl: 'intermediate', >350 cells/μl: 'early') and with HIV-uninfected individuals from the Multicenter AIDS Cohort Study and the Women's Interagency HIV Study. We used multiple imputation methods to address lead-time bias in sensitivity analysis.

RESULTS:

Earlier initiators were more likely to die of non-AIDS causes (early: 78%, intermediate: 74%, late: 49%), and at older ages (median years 72, 69, 66), relative to later initiators. Estimated median ages at non-AIDS death for each CD4 cell count category were lower than that estimated for the HIV-uninfected group (75 years). In multivariable analysis, non-AIDS death hazard ratios relative to early initiators were 2.15 for late initiators (P < 0.01) and 1.66 for intermediate initiators (P = 0.01); AIDS death hazard ratios were 3.26 for late initiators (P < 0.01) and 1.20 for intermediate initiators (P = 0.28). Strikingly, the adjusted hazards for non-AIDS death among HIV-uninfected individuals and early initiators were nearly identical (hazard ratio 1.01). Inferences were unchanged after adjustment for lead-time bias.

CONCLUSION:

Results suggest the possibility of reducing the risk of non-AIDS mortality among HIV-infected individuals to approximate that faced by comparable HIV-uninfected individuals.

• Authors: Nikolas Wada, Lisa P Jacobson, Mardge Cohen, Audrey French, John Phair, Alvaro Muñoz
• Journal: AIDS (London, England) (AIDS) Vol. 28 Issue 2 Pg. 257-65 (Jan 14 2014) ISSN: 1473-5571 [Electronic] England
• PMID: 24105030 (Publication Type: Journal Article, Multicenter Study, Research Support, N.I.H., Extramural)

Chemical References

• Anti-Retroviral Agents

Topics

• Adult
• Aged
• Anti-Retroviral Agents (administration & dosage)
• CD4 Lymphocyte Count
• Cohort Studies
• Female
• HIV Infections (drug therapy, mortality)
• Humans
• Male
• Middle Aged
• Prospective Studies
• Survival Analysis