HIV-positive adults with CD4 >500 cells/mm3 have similar mortality rates as the general population after seven years ARV treatment

Charlotte Lewden and colleagues published an analysis of life-expectancy in a subgroup of patients on long-term PI-based HAART, from two French cohorts, in the September 2007 edition of JAIDS.

A total of 2435 patients the Aproco-Copilote and Aquitaine cohorts, who started protease inhibitor-based combination therapy during 1997-1999, were included in the analysis. There was a median follow-up of 6.8 years since starting combination therapy (IQR 4.1 to 7.9, 13,970 patient years (PYs). Standardised mortality ratios (SMRs) were compared to the general population. [1]

Baseline demographics included 77% men, median age 36, and median CD4 count 270 cells/mm³. 16% of patients had a CD4 cell count =500 cells/mm³, and 19% of patients had a CD4 cell count between 350 and 499 cells/mm³. 21% transmission by IDU. 29% of patients were HCV infected (88% among patients infected through injecting drug use. 39% patients had previously been prescribed mono or dual therapy.

After adjusting for age and gender, overall mortality remained 7-fold higher in HIV-infected adults than in the general population (95% confidence interval [CI]: 6.2 to 7.8). Mortality was 4.8 in men and 13.0 in women, 16.3 in injecting drug users, and 13.9 in HCV-coinfected patients.

SMRs were also estimated according to HIV transmission group (injecting drug use vs. others) and hepatitis C virus (HCV) coinfection as defined by the presence of HCV antibody or plasma HCV RNA at baseline, because similar types of analyses reported higher mortality ratios in these groups.

However, mortality rates became similar to that of the general population after the sixth year of follow-up among patients whose CD4 counts had reached 500 cells/mm³ (49% of the 1430 patients still followed at 6 years, SMR 0.5, 95% CI: 0.1 to 1.6).

The authors concluded that these results remain to be confirmed in other populations, and cohort collaborations may address this question with a larger sample size and a longer follow-up.

Identifying this good prognosis for patients achieving CD4 counts >500 cells/mL on stable long-term treatment was suggested as evidence of the important of starting treatment while such a CD4 response could be expected.

This study was presented in part at the EACS conference in Dublin two years ago.

Lewden C et al for ANRS APROCO-COPILOTE and CO3 AQUITAINE Study Groups. HIV-Infected Adults With a CD4 Cell Count Greater Than 500 Cells/mm³ on Long-Term HAART Reach Same Mortality Rates as the General Population. JAIDS Journal of Acquired Immune Deficiency Syndromes: Volume 46(1)1 September 2007pp 72-77.