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

Wada, Nikolas; Jacobson, Lisa P.; Cohen, Mardge; French, Audrey; Phair, John; Muñoz, Alvaro

doi:10.1097/QAD.0000000000000078

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

1 14 2014
By Wada, Nikolas ; Jacobson, Lisa P. ; Cohen, Mardge ; ...
http://dx.doi.org/10.1097/QAD.0000000000000078
Source: AIDS. 2014; 28(2):257-265

[PDF-380.43 KB]

English

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Details:

Alternative Title:

AIDS
Personal Author:

Wada, Nikolas ; Jacobson, Lisa P. ; Cohen, Mardge ; French, Audrey ; Phair, John ; ... More +

Wada, Nikolas ; Jacobson, Lisa P. ; Cohen, Mardge ; French, Audrey ; Phair, John ; Muñoz, Alvaro Less -
Description:

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.
Keywords:

[+]

Adult Aged Anti-Retroviral Agents Antiretroviral Therapy Bias CD4 Lymphocyte Count CD4+ Cell Count Cohort Studies Competing Risks Female HIV Infections Humans Male Middle Aged Mortality Prospective Studies Statistical Survival Analysis
Source:

AIDS. 2014; 28(2):257-265
Pubmed ID:

24105030
Pubmed Central ID:

PMC4164055
Document Type:

Journal Article
Funding:

U01 AI035042/AI/NIAID NIH HHSUnited States/ ; M01 RR000079/RR/NCRR NIH HHSUnited States/ ; UO1-AI-34994/AI/NIAID NIH HHSUnited States/ ; UO1-AI-34989/AI/NIAID NIH HHSUnited States/ ; UO1-AI-35042/AI/NIAID NIH HHSUnited States/ ; ... More +

U01 AI035042/AI/NIAID NIH HHSUnited States/ ; M01 RR000079/RR/NCRR NIH HHSUnited States/ ; UO1-AI-34994/AI/NIAID NIH HHSUnited States/ ; UO1-AI-34989/AI/NIAID NIH HHSUnited States/ ; UO1-AI-35042/AI/NIAID NIH HHSUnited States/ ; U01 AI035004/AI/NIAID NIH HHSUnited States/ ; UO1-CH-32632/CH/OID CDC HHSUnited States/ ; UO1-AI-35040/AI/NIAID NIH HHSUnited States/ ; U01 AI034989/AI/NIAID NIH HHSUnited States/ ; UO1-AI-35004/AI/NIAID NIH HHSUnited States/ ; UM1 AI035043/AI/NIAID NIH HHSUnited States/ ; UO1-AI-34993/AI/NIAID NIH HHSUnited States/ ; U01 AI034994/AI/NIAID NIH HHSUnited States/ ; MO1-RR-00079/RR/NCRR NIH HHSUnited States/ ; UL1-RR025005/RR/NCRR NIH HHSUnited States/ ; UO1-AI-35039/AI/NIAID NIH HHSUnited States/ ; U01 AI034993/AI/NIAID NIH HHSUnited States/ ; U01 AI035039/AI/NIAID NIH HHSUnited States/ ; UL1 RR025005/RR/NCRR NIH HHSUnited States/ ; MO1-RR-00083/RR/NCRR NIH HHSUnited States/ ; U01 AI031834/AI/NIAID NIH HHSUnited States/ ; UO1-AI-35041/AI/NIAID NIH HHSUnited States/ ; M01 RR000071/RR/NCRR NIH HHSUnited States/ ; U01 AI035041/AI/NIAID NIH HHSUnited States/ ; UM1-AI-35043/AI/NIAID NIH HHSUnited States/ ; UO1-AI-42590/AI/NIAID NIH HHSUnited States/ ; U01 AI035040/AI/NIAID NIH HHSUnited States/ ; UO1-AI-31834/AI/NIAID NIH HHSUnited States/ ; M01 RR000083/RR/NCRR NIH HHSUnited States/ ; MO1-RR-00071/RR/NCRR NIH HHSUnited States/ ; U01 HD032632/HD/NICHD NIH HHSUnited States/ ; U01 AI042590/AI/NIAID NIH HHSUnited States/ Less -
Volume:

28
Issue:

2
Collection(s):

CDC Public Access
Main Document Checksum:

[+]

urn:sha256:468e8044e56bf841881c8d81c7326ad03bfad14b8938f136153c3018f8f5c884
Download URL:

https://stacks.cdc.gov/view/cdc/30119/cdc_30119_DS1.pdf
File Type:

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