Cause-specific mortality among HIV-infected individuals, by CD4+ cell count at HAART initiation, compared with HIV-uninfected individuals
Published Date:Jan 14 2014
Source:AIDS. 2014; 28(2):257-265.
Pubmed Central ID:PMC4164055
Funding:MO1-RR-00071/RR/NCRR NIH HHS/United States
MO1-RR-00079/RR/NCRR NIH HHS/United States
MO1-RR-00083/RR/NCRR NIH HHS/United States
U01 AI031834/AI/NIAID NIH HHS/United States
U01 AI034989/AI/NIAID NIH HHS/United States
U01 AI034993/AI/NIAID NIH HHS/United States
U01 AI034994/AI/NIAID NIH HHS/United States
U01 AI035004/AI/NIAID NIH HHS/United States
U01 AI035039/AI/NIAID NIH HHS/United States
U01 AI035040/AI/NIAID NIH HHS/United States
U01 AI035041/AI/NIAID NIH HHS/United States
U01 AI035042/AI/NIAID NIH HHS/United States
U01 AI042590/AI/NIAID NIH HHS/United States
U01 HD032632/HD/NICHD NIH HHS/United States
UL1 RR025005/RR/NCRR NIH HHS/United States
UL1-RR025005/RR/NCRR NIH HHS/United States
UM1 AI035043/AI/NIAID NIH HHS/United States
UM1-AI-35043/AI/NIAID NIH HHS/United States
UO1-AI-31834/AI/NIAID NIH HHS/United States
UO1-AI-34989/AI/NIAID NIH HHS/United States
UO1-AI-34993/AI/NIAID NIH HHS/United States
UO1-AI-34994/AI/NIAID NIH HHS/United States
UO1-AI-35004/AI/NIAID NIH HHS/United States
UO1-AI-35039/AI/NIAID NIH HHS/United States
UO1-AI-35040/AI/NIAID NIH HHS/United States
UO1-AI-35041/AI/NIAID NIH HHS/United States
UO1-AI-35042/AI/NIAID NIH HHS/United States
UO1-AI-42590/AI/NIAID NIH HHS/United States
UO1-CH-32632/CH/OID CDC HHS/United States
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.
Prospective cohort studies.
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.
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.
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.
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