Death rates in HIV-positive antiretroviral-naive patients with CD4 count greater than 350 cells per μl in Europe and North America: A pooled cohort observational study

Rebecca K. Lodwick; Caroline A. Sabin; Kholoud Porter; Bruno Ledergerber; Ard Van Sighem; Alessandro Cozzi-Lepri; Pavel Khaykin; Amanda Mocroft; L. P. Jacobson; Stephane De Wit; Niels Obel; Antonella Castagna; Jan Christian Wasmuth; John Gill; Marina B. Klein; Stephen Gange; Melchor Riera; Cristina Mussini; Félix Gutiérrez; Giota Touloumi; Patrizia Carrieri; Jodie L. Guest; Norbert H. Brockmeyer; Andrew N. Phillips; A. Antoniadou; P. Gargalianos-Kakolyris; O. Katsarou; T. Kordossis; M. Lazanas; G. Panos; V. Paparizos; D. Paraskevis; G. Petrikkos; H. Sambatakou; A. Skoutelis; N. Pantazis; G. Bakoyannis; V. Gioukari; F. de Wolf; D. O Bezemer; L. A.J. Gras; A. M. Kesselring; A. I. van Sighem; C. Smit; S. Zhang; S. Zaheri; J. M. Prins; G. Schreij; B. Bravenboer; M. E. van der Ende; R. H. Kauff mann; R. W. ten Kate; F. P. Kroon; W. Bronsveld; R. Vriesendorp; D. van Houte; C. H.H. ten Napel; K. Brinkman; A. van Eeden; J. W. Mulder; J. R. Juttmann; J. Veenstra; P. P. Koopmans; H. G. Sprenger; I. M. Hoepelman; S. A. Danner; C. Richter; A. A. Tanis; A. Van; M. Delforge; C. Necsoi; R. Demeester; A. F. Gennotte; M. Gerard; M. P. Guillaume; P. Hermans; K. Kabeya; D. Konopnicki; C. Martin; A. Libois; M. C. Payen; P. Semaille; Y. Van Laethem; J. Del Amo; L. Meyer; H. C. Bucher; G. Chêne; D. Pillay; J. M. Prins; M. Rosinska; Caroline A. Sabin; Giota Touloumi; S. Lodi; K. Coughlin; S. Walker; A. Babiker; A. de Luca; M. Fisher; R. Muga; G. Fätkenheuer

doi:10.1016/S0140-6736(10)60932-4

Death rates in HIV-positive antiretroviral-naive patients with CD4 count greater than 350 cells per μl in Europe and North America: A pooled cohort observational study

Rebecca K. Lodwick, Caroline A. Sabin, Kholoud Porter, Bruno Ledergerber, Ard Van Sighem, Alessandro Cozzi-Lepri, Pavel Khaykin, Amanda Mocroft, L. P. Jacobson, Stephane De Wit, Niels Obel, Antonella Castagna, Jan Christian Wasmuth, John Gill, Marina B. Klein, Stephen Gange, Melchor Riera, Cristina Mussini, Félix Gutiérrez, Giota TouloumiPatrizia Carrieri, Jodie L. Guest, Norbert H. Brockmeyer, Andrew N. Phillips, A. Antoniadou, P. Gargalianos-Kakolyris, O. Katsarou, T. Kordossis, M. Lazanas, G. Panos, V. Paparizos, D. Paraskevis, G. Petrikkos, H. Sambatakou, A. Skoutelis, N. Pantazis, G. Bakoyannis, V. Gioukari, F. de Wolf, D. O Bezemer, L. A.J. Gras, A. M. Kesselring, A. I. van Sighem, C. Smit, S. Zhang, S. Zaheri, J. M. Prins, G. Schreij, B. Bravenboer, M. E. van der Ende, R. H. Kauff mann, R. W. ten Kate, F. P. Kroon, W. Bronsveld, R. Vriesendorp, D. van Houte, C. H.H. ten Napel, K. Brinkman, A. van Eeden, J. W. Mulder, J. R. Juttmann, J. Veenstra, P. P. Koopmans, H. G. Sprenger, I. M. Hoepelman, S. A. Danner, C. Richter, A. A. Tanis, A. Van, M. Delforge, C. Necsoi, R. Demeester, A. F. Gennotte, M. Gerard, M. P. Guillaume, P. Hermans, K. Kabeya, D. Konopnicki, C. Martin, A. Libois, M. C. Payen, P. Semaille, Y. Van Laethem, J. Del Amo, L. Meyer, H. C. Bucher, G. Chêne, D. Pillay, J. M. Prins, M. Rosinska, Caroline A. Sabin, Giota Touloumi, S. Lodi, K. Coughlin, S. Walker, A. Babiker, A. de Luca, M. Fisher, R. Muga, G. Fätkenheuer

Department of Medicine

Research output: Contribution to journal › Article › Research › peer-review

72 Citations (Scopus)

Abstract

Summary Background Whether people living with HIV who have not received antiretroviral therapy (ART) and have high CD4 cell counts have higher mortality than the general population is unknown. We aimed to examine this by analysis of pooled data from industrialised countries. We merged data on demographics, CD4 cell counts, viral-load measurements, hepatitis C co-infection status, smoking status, date of death, and whether death was AIDS-related or not from 23 European and North American cohorts. We calculated standardised mortality ratios (SMRs) standardised by age, sex, and year, stratifying by risk group. Data were included for patients aged 20-59 years who had at least one CD4 count greater than 350 cells per μL while ART naive. All pre-ART CD4 counts greater than 350 cells per μL from January, 1990, to December, 2004, were included. We investigated mortality for four risk groups - men who have sex with men, heterosexual people, injecting drug users, and those at other or unknown risk. The association between CD4 cell count and death rate was investigated by use of Poisson regression methods. Data were analysed for 40 830 patients contributing 80 682 person-years of follow-up. Of 419 deaths, 401 were used in the SMR analysis: 100 men who have sex with men (SMR 1·30, 95 CI 1·06-1·58); 68 heterosexual people (2·94, 2·28-3·73); 203 injecting drug users (9·37, 8·13-10·75); and 30 in the other or unknown risk category (4·57, 3·09-6·53). Compared with CD4 counts of 350-499 cells per μL, death rate was lower in patients with counts of 500-699 cells per μL (adjusted rate ratio 0·77, 95 CI 0·61-0·95) and counts of 700 cells per μL (0·66, 0·52-0·85). In HIV-infected ART-naive patients with high CD4 cell counts, death rates were raised compared with the general population. In men who have sex with men this was modest, suggesting that a substantial proportion of the increased risk in other groups is due to confounding by other factors. Even though the increased risk is small, new studies of potential benefits of ART in this group are merited. European Commission, FP6. European AIDS Treatment Network (NEAT). Project number LSHP-CT-2006-037570. © 2010 Elsevier Ltd.

Original language	English
Pages (from-to)	340-345
Journal	The Lancet
Volume	376
Issue number	9738
DOIs	https://doi.org/10.1016/S0140-6736(10)60932-4
Publication status	Published - 31 Jul 2010

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Lodwick, R. K., Sabin, C. A., Porter, K., Ledergerber, B., Van Sighem, A., Cozzi-Lepri, A., Khaykin, P., Mocroft, A., Jacobson, L. P., De Wit, S., Obel, N., Castagna, A., Wasmuth, J. C., Gill, J., Klein, M. B., Gange, S., Riera, M., Mussini, C., Gutiérrez, F., ... Fätkenheuer, G. (2010). Death rates in HIV-positive antiretroviral-naive patients with CD4 count greater than 350 cells per μl in Europe and North America: A pooled cohort observational study. The Lancet, 376(9738), 340-345. https://doi.org/10.1016/S0140-6736(10)60932-4

Lodwick, Rebecca K. ; Sabin, Caroline A. ; Porter, Kholoud ; Ledergerber, Bruno ; Van Sighem, Ard ; Cozzi-Lepri, Alessandro ; Khaykin, Pavel ; Mocroft, Amanda ; Jacobson, L. P. ; De Wit, Stephane ; Obel, Niels ; Castagna, Antonella ; Wasmuth, Jan Christian ; Gill, John ; Klein, Marina B. ; Gange, Stephen ; Riera, Melchor ; Mussini, Cristina ; Gutiérrez, Félix ; Touloumi, Giota ; Carrieri, Patrizia ; Guest, Jodie L. ; Brockmeyer, Norbert H. ; Phillips, Andrew N. ; Antoniadou, A. ; Gargalianos-Kakolyris, P. ; Katsarou, O. ; Kordossis, T. ; Lazanas, M. ; Panos, G. ; Paparizos, V. ; Paraskevis, D. ; Petrikkos, G. ; Sambatakou, H. ; Skoutelis, A. ; Pantazis, N. ; Bakoyannis, G. ; Gioukari, V. ; de Wolf, F. ; O Bezemer, D. ; Gras, L. A.J. ; Kesselring, A. M. ; van Sighem, A. I. ; Smit, C. ; Zhang, S. ; Zaheri, S. ; Prins, J. M. ; Schreij, G. ; Bravenboer, B. ; van der Ende, M. E. ; Kauff mann, R. H. ; ten Kate, R. W. ; Kroon, F. P. ; Bronsveld, W. ; Vriesendorp, R. ; van Houte, D. ; ten Napel, C. H.H. ; Brinkman, K. ; van Eeden, A. ; Mulder, J. W. ; Juttmann, J. R. ; Veenstra, J. ; Koopmans, P. P. ; Sprenger, H. G. ; Hoepelman, I. M. ; Danner, S. A. ; Richter, C. ; Tanis, A. A. ; Van, A. ; Delforge, M. ; Necsoi, C. ; Demeester, R. ; Gennotte, A. F. ; Gerard, M. ; Guillaume, M. P. ; Hermans, P. ; Kabeya, K. ; Konopnicki, D. ; Martin, C. ; Libois, A. ; Payen, M. C. ; Semaille, P. ; Van Laethem, Y. ; Del Amo, J. ; Meyer, L. ; Bucher, H. C. ; Chêne, G. ; Pillay, D. ; Prins, J. M. ; Rosinska, M. ; Sabin, Caroline A. ; Touloumi, Giota ; Lodi, S. ; Coughlin, K. ; Walker, S. ; Babiker, A. ; de Luca, A. ; Fisher, M. ; Muga, R. ; Fätkenheuer, G. / Death rates in HIV-positive antiretroviral-naive patients with CD4 count greater than 350 cells per μl in Europe and North America: A pooled cohort observational study. In: The Lancet. 2010 ; Vol. 376, No. 9738. pp. 340-345.

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title = "Death rates in HIV-positive antiretroviral-naive patients with CD4 count greater than 350 cells per μl in Europe and North America: A pooled cohort observational study",

abstract = "Summary Background Whether people living with HIV who have not received antiretroviral therapy (ART) and have high CD4 cell counts have higher mortality than the general population is unknown. We aimed to examine this by analysis of pooled data from industrialised countries. We merged data on demographics, CD4 cell counts, viral-load measurements, hepatitis C co-infection status, smoking status, date of death, and whether death was AIDS-related or not from 23 European and North American cohorts. We calculated standardised mortality ratios (SMRs) standardised by age, sex, and year, stratifying by risk group. Data were included for patients aged 20-59 years who had at least one CD4 count greater than 350 cells per μL while ART naive. All pre-ART CD4 counts greater than 350 cells per μL from January, 1990, to December, 2004, were included. We investigated mortality for four risk groups - men who have sex with men, heterosexual people, injecting drug users, and those at other or unknown risk. The association between CD4 cell count and death rate was investigated by use of Poisson regression methods. Data were analysed for 40 830 patients contributing 80 682 person-years of follow-up. Of 419 deaths, 401 were used in the SMR analysis: 100 men who have sex with men (SMR 1·30, 95 CI 1·06-1·58); 68 heterosexual people (2·94, 2·28-3·73); 203 injecting drug users (9·37, 8·13-10·75); and 30 in the other or unknown risk category (4·57, 3·09-6·53). Compared with CD4 counts of 350-499 cells per μL, death rate was lower in patients with counts of 500-699 cells per μL (adjusted rate ratio 0·77, 95 CI 0·61-0·95) and counts of 700 cells per μL (0·66, 0·52-0·85). In HIV-infected ART-naive patients with high CD4 cell counts, death rates were raised compared with the general population. In men who have sex with men this was modest, suggesting that a substantial proportion of the increased risk in other groups is due to confounding by other factors. Even though the increased risk is small, new studies of potential benefits of ART in this group are merited. European Commission, FP6. European AIDS Treatment Network (NEAT). Project number LSHP-CT-2006-037570. {\textcopyright} 2010 Elsevier Ltd.",

author = "Lodwick, {Rebecca K.} and Sabin, {Caroline A.} and Kholoud Porter and Bruno Ledergerber and {Van Sighem}, Ard and Alessandro Cozzi-Lepri and Pavel Khaykin and Amanda Mocroft and Jacobson, {L. P.} and {De Wit}, Stephane and Niels Obel and Antonella Castagna and Wasmuth, {Jan Christian} and John Gill and Klein, {Marina B.} and Stephen Gange and Melchor Riera and Cristina Mussini and F{\'e}lix Guti{\'e}rrez and Giota Touloumi and Patrizia Carrieri and Guest, {Jodie L.} and Brockmeyer, {Norbert H.} and Phillips, {Andrew N.} and A. Antoniadou and P. Gargalianos-Kakolyris and O. Katsarou and T. Kordossis and M. Lazanas and G. Panos and V. Paparizos and D. Paraskevis and G. Petrikkos and H. Sambatakou and A. Skoutelis and N. Pantazis and G. Bakoyannis and V. Gioukari and {de Wolf}, F. and {O Bezemer}, D. and Gras, {L. A.J.} and Kesselring, {A. M.} and {van Sighem}, {A. I.} and C. Smit and S. Zhang and S. Zaheri and Prins, {J. M.} and G. Schreij and B. Bravenboer and {van der Ende}, {M. E.} and {Kauff mann}, {R. H.} and {ten Kate}, {R. W.} and Kroon, {F. P.} and W. Bronsveld and R. Vriesendorp and {van Houte}, D. and {ten Napel}, {C. H.H.} and K. Brinkman and {van Eeden}, A. and Mulder, {J. W.} and Juttmann, {J. R.} and J. Veenstra and Koopmans, {P. P.} and Sprenger, {H. G.} and Hoepelman, {I. M.} and Danner, {S. A.} and C. Richter and Tanis, {A. A.} and A. Van and M. Delforge and C. Necsoi and R. Demeester and Gennotte, {A. F.} and M. Gerard and Guillaume, {M. P.} and P. Hermans and K. Kabeya and D. Konopnicki and C. Martin and A. Libois and Payen, {M. C.} and P. Semaille and {Van Laethem}, Y. and {Del Amo}, J. and L. Meyer and Bucher, {H. C.} and G. Ch{\^e}ne and D. Pillay and Prins, {J. M.} and M. Rosinska and Sabin, {Caroline A.} and Giota Touloumi and S. Lodi and K. Coughlin and S. Walker and A. Babiker and {de Luca}, A. and M. Fisher and R. Muga and G. F{\"a}tkenheuer",

year = "2010",

month = jul,

day = "31",

doi = "10.1016/S0140-6736(10)60932-4",

language = "English",

volume = "376",

pages = "340--345",

number = "9738",

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Lodwick, RK, Sabin, CA, Porter, K, Ledergerber, B, Van Sighem, A, Cozzi-Lepri, A, Khaykin, P, Mocroft, A, Jacobson, LP, De Wit, S, Obel, N, Castagna, A, Wasmuth, JC, Gill, J, Klein, MB, Gange, S, Riera, M, Mussini, C, Gutiérrez, F, Touloumi, G, Carrieri, P, Guest, JL, Brockmeyer, NH, Phillips, AN, Antoniadou, A, Gargalianos-Kakolyris, P, Katsarou, O, Kordossis, T, Lazanas, M, Panos, G, Paparizos, V, Paraskevis, D, Petrikkos, G, Sambatakou, H, Skoutelis, A, Pantazis, N, Bakoyannis, G, Gioukari, V, de Wolf, F, O Bezemer, D, Gras, LAJ, Kesselring, AM, van Sighem, AI, Smit, C, Zhang, S, Zaheri, S, Prins, JM, Schreij, G, Bravenboer, B, van der Ende, ME, Kauff mann, RH, ten Kate, RW, Kroon, FP, Bronsveld, W, Vriesendorp, R, van Houte, D, ten Napel, CHH, Brinkman, K, van Eeden, A, Mulder, JW, Juttmann, JR, Veenstra, J, Koopmans, PP, Sprenger, HG, Hoepelman, IM, Danner, SA, Richter, C, Tanis, AA, Van, A, Delforge, M, Necsoi, C, Demeester, R, Gennotte, AF, Gerard, M, Guillaume, MP, Hermans, P, Kabeya, K, Konopnicki, D, Martin, C, Libois, A, Payen, MC, Semaille, P, Van Laethem, Y, Del Amo, J, Meyer, L, Bucher, HC, Chêne, G, Pillay, D, Prins, JM, Rosinska, M, Sabin, CA, Touloumi, G, Lodi, S, Coughlin, K, Walker, S, Babiker, A, de Luca, A, Fisher, M, Muga, R & Fätkenheuer, G 2010, 'Death rates in HIV-positive antiretroviral-naive patients with CD4 count greater than 350 cells per μl in Europe and North America: A pooled cohort observational study', The Lancet, vol. 376, no. 9738, pp. 340-345. https://doi.org/10.1016/S0140-6736(10)60932-4

Death rates in HIV-positive antiretroviral-naive patients with CD4 count greater than 350 cells per μl in Europe and North America: A pooled cohort observational study. / Lodwick, Rebecca K.; Sabin, Caroline A.; Porter, Kholoud; Ledergerber, Bruno; Van Sighem, Ard; Cozzi-Lepri, Alessandro; Khaykin, Pavel; Mocroft, Amanda; Jacobson, L. P.; De Wit, Stephane; Obel, Niels; Castagna, Antonella; Wasmuth, Jan Christian; Gill, John; Klein, Marina B.; Gange, Stephen; Riera, Melchor; Mussini, Cristina; Gutiérrez, Félix; Touloumi, Giota; Carrieri, Patrizia; Guest, Jodie L.; Brockmeyer, Norbert H.; Phillips, Andrew N.; Antoniadou, A.; Gargalianos-Kakolyris, P.; Katsarou, O.; Kordossis, T.; Lazanas, M.; Panos, G.; Paparizos, V.; Paraskevis, D.; Petrikkos, G.; Sambatakou, H.; Skoutelis, A.; Pantazis, N.; Bakoyannis, G.; Gioukari, V.; de Wolf, F.; O Bezemer, D.; Gras, L. A.J.; Kesselring, A. M.; van Sighem, A. I.; Smit, C.; Zhang, S.; Zaheri, S.; Prins, J. M.; Schreij, G.; Bravenboer, B.; van der Ende, M. E.; Kauff mann, R. H.; ten Kate, R. W.; Kroon, F. P.; Bronsveld, W.; Vriesendorp, R.; van Houte, D.; ten Napel, C. H.H.; Brinkman, K.; van Eeden, A.; Mulder, J. W.; Juttmann, J. R.; Veenstra, J.; Koopmans, P. P.; Sprenger, H. G.; Hoepelman, I. M.; Danner, S. A.; Richter, C.; Tanis, A. A.; Van, A.; Delforge, M.; Necsoi, C.; Demeester, R.; Gennotte, A. F.; Gerard, M.; Guillaume, M. P.; Hermans, P.; Kabeya, K.; Konopnicki, D.; Martin, C.; Libois, A.; Payen, M. C.; Semaille, P.; Van Laethem, Y.; Del Amo, J.; Meyer, L.; Bucher, H. C.; Chêne, G.; Pillay, D.; Prins, J. M.; Rosinska, M.; Sabin, Caroline A.; Touloumi, Giota; Lodi, S.; Coughlin, K.; Walker, S.; Babiker, A.; de Luca, A.; Fisher, M.; Muga, R.; Fätkenheuer, G.

In: The Lancet, Vol. 376, No. 9738, 31.07.2010, p. 340-345.

Research output: Contribution to journal › Article › Research › peer-review

TY - JOUR

T1 - Death rates in HIV-positive antiretroviral-naive patients with CD4 count greater than 350 cells per μl in Europe and North America: A pooled cohort observational study

AU - Lodwick, Rebecca K.

AU - Sabin, Caroline A.

AU - Porter, Kholoud

AU - Ledergerber, Bruno

AU - Van Sighem, Ard

AU - Cozzi-Lepri, Alessandro

AU - Khaykin, Pavel

AU - Mocroft, Amanda

AU - Jacobson, L. P.

AU - De Wit, Stephane

AU - Obel, Niels

AU - Castagna, Antonella

AU - Wasmuth, Jan Christian

AU - Gill, John

AU - Klein, Marina B.

AU - Gange, Stephen

AU - Riera, Melchor

AU - Mussini, Cristina

AU - Gutiérrez, Félix

AU - Touloumi, Giota

AU - Carrieri, Patrizia

AU - Guest, Jodie L.

AU - Brockmeyer, Norbert H.

AU - Phillips, Andrew N.

AU - Antoniadou, A.

AU - Gargalianos-Kakolyris, P.

AU - Katsarou, O.

AU - Kordossis, T.

AU - Lazanas, M.

AU - Panos, G.

AU - Paparizos, V.

AU - Paraskevis, D.

AU - Petrikkos, G.

AU - Sambatakou, H.

AU - Skoutelis, A.

AU - Pantazis, N.

AU - Bakoyannis, G.

AU - Gioukari, V.

AU - de Wolf, F.

AU - O Bezemer, D.

AU - Gras, L. A.J.

AU - Kesselring, A. M.

AU - van Sighem, A. I.

AU - Smit, C.

AU - Zhang, S.

AU - Zaheri, S.

AU - Prins, J. M.

AU - Schreij, G.

AU - Bravenboer, B.

AU - van der Ende, M. E.

AU - Kauff mann, R. H.

AU - ten Kate, R. W.

AU - Kroon, F. P.

AU - Bronsveld, W.

AU - Vriesendorp, R.

AU - van Houte, D.

AU - ten Napel, C. H.H.

AU - Brinkman, K.

AU - van Eeden, A.

AU - Mulder, J. W.

AU - Juttmann, J. R.

AU - Veenstra, J.

AU - Koopmans, P. P.

AU - Sprenger, H. G.

AU - Hoepelman, I. M.

AU - Danner, S. A.

AU - Richter, C.

AU - Tanis, A. A.

AU - Van, A.

AU - Delforge, M.

AU - Necsoi, C.

AU - Demeester, R.

AU - Gennotte, A. F.

AU - Gerard, M.

AU - Guillaume, M. P.

AU - Hermans, P.

AU - Kabeya, K.

AU - Konopnicki, D.

AU - Martin, C.

AU - Libois, A.

AU - Payen, M. C.

AU - Semaille, P.

AU - Van Laethem, Y.

AU - Del Amo, J.

AU - Meyer, L.

AU - Bucher, H. C.

AU - Chêne, G.

AU - Pillay, D.

AU - Prins, J. M.

AU - Rosinska, M.

AU - Sabin, Caroline A.

AU - Touloumi, Giota

AU - Lodi, S.

AU - Coughlin, K.

AU - Walker, S.

AU - Babiker, A.

AU - de Luca, A.

AU - Fisher, M.

AU - Muga, R.

AU - Fätkenheuer, G.

PY - 2010/7/31

Y1 - 2010/7/31

N2 - Summary Background Whether people living with HIV who have not received antiretroviral therapy (ART) and have high CD4 cell counts have higher mortality than the general population is unknown. We aimed to examine this by analysis of pooled data from industrialised countries. We merged data on demographics, CD4 cell counts, viral-load measurements, hepatitis C co-infection status, smoking status, date of death, and whether death was AIDS-related or not from 23 European and North American cohorts. We calculated standardised mortality ratios (SMRs) standardised by age, sex, and year, stratifying by risk group. Data were included for patients aged 20-59 years who had at least one CD4 count greater than 350 cells per μL while ART naive. All pre-ART CD4 counts greater than 350 cells per μL from January, 1990, to December, 2004, were included. We investigated mortality for four risk groups - men who have sex with men, heterosexual people, injecting drug users, and those at other or unknown risk. The association between CD4 cell count and death rate was investigated by use of Poisson regression methods. Data were analysed for 40 830 patients contributing 80 682 person-years of follow-up. Of 419 deaths, 401 were used in the SMR analysis: 100 men who have sex with men (SMR 1·30, 95 CI 1·06-1·58); 68 heterosexual people (2·94, 2·28-3·73); 203 injecting drug users (9·37, 8·13-10·75); and 30 in the other or unknown risk category (4·57, 3·09-6·53). Compared with CD4 counts of 350-499 cells per μL, death rate was lower in patients with counts of 500-699 cells per μL (adjusted rate ratio 0·77, 95 CI 0·61-0·95) and counts of 700 cells per μL (0·66, 0·52-0·85). In HIV-infected ART-naive patients with high CD4 cell counts, death rates were raised compared with the general population. In men who have sex with men this was modest, suggesting that a substantial proportion of the increased risk in other groups is due to confounding by other factors. Even though the increased risk is small, new studies of potential benefits of ART in this group are merited. European Commission, FP6. European AIDS Treatment Network (NEAT). Project number LSHP-CT-2006-037570. © 2010 Elsevier Ltd.

AB - Summary Background Whether people living with HIV who have not received antiretroviral therapy (ART) and have high CD4 cell counts have higher mortality than the general population is unknown. We aimed to examine this by analysis of pooled data from industrialised countries. We merged data on demographics, CD4 cell counts, viral-load measurements, hepatitis C co-infection status, smoking status, date of death, and whether death was AIDS-related or not from 23 European and North American cohorts. We calculated standardised mortality ratios (SMRs) standardised by age, sex, and year, stratifying by risk group. Data were included for patients aged 20-59 years who had at least one CD4 count greater than 350 cells per μL while ART naive. All pre-ART CD4 counts greater than 350 cells per μL from January, 1990, to December, 2004, were included. We investigated mortality for four risk groups - men who have sex with men, heterosexual people, injecting drug users, and those at other or unknown risk. The association between CD4 cell count and death rate was investigated by use of Poisson regression methods. Data were analysed for 40 830 patients contributing 80 682 person-years of follow-up. Of 419 deaths, 401 were used in the SMR analysis: 100 men who have sex with men (SMR 1·30, 95 CI 1·06-1·58); 68 heterosexual people (2·94, 2·28-3·73); 203 injecting drug users (9·37, 8·13-10·75); and 30 in the other or unknown risk category (4·57, 3·09-6·53). Compared with CD4 counts of 350-499 cells per μL, death rate was lower in patients with counts of 500-699 cells per μL (adjusted rate ratio 0·77, 95 CI 0·61-0·95) and counts of 700 cells per μL (0·66, 0·52-0·85). In HIV-infected ART-naive patients with high CD4 cell counts, death rates were raised compared with the general population. In men who have sex with men this was modest, suggesting that a substantial proportion of the increased risk in other groups is due to confounding by other factors. Even though the increased risk is small, new studies of potential benefits of ART in this group are merited. European Commission, FP6. European AIDS Treatment Network (NEAT). Project number LSHP-CT-2006-037570. © 2010 Elsevier Ltd.

U2 - 10.1016/S0140-6736(10)60932-4

DO - 10.1016/S0140-6736(10)60932-4

M3 - Article

VL - 376

SP - 340

EP - 345

IS - 9738

ER -