| Death rates in HIV-positive antiretroviral-naive patients with CD4 count greater than 350 cells per microL in Europe and North America: a pooled cohort observational study. | |
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MedLine Citation:
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PMID: 20638118 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. METHODS: 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 microL while ART naive. All pre-ART CD4 counts greater than 350 cells per microL 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. FINDINGS: 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 microL, death rate was lower in patients with counts of 500-699 cells per microL (adjusted rate ratio 0.77, 95% CI 0.61-0.95) and counts of 700 cells per microL (0.66, 0.52-0.85). INTERPRETATION: 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. FUNDING: European Commission, FP6. European AIDS Treatment Network (NEAT). Project number LSHP-CT-2006-037570. |
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Authors:
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; Rebecca K Lodwick; Caroline A Sabin; Kholoud Porter; Bruno Ledergerber; Ard van Sighem; Alessandro Cozzi-Lepri; Pavel Khaykin; Amanda Mocroft; Lisa 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 |
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Publication Detail:
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Type: Comparative Study; Journal Article; Meta-Analysis; Multicenter Study; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't Date: 2010-07-15 |
Journal Detail:
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Title: Lancet Volume: 376 ISSN: 1474-547X ISO Abbreviation: Lancet Publication Date: 2010 Jul |
Date Detail:
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Created Date: 2010-08-02 Completed Date: 2010-08-16 Revised Date: 2011-09-26 |
Medline Journal Info:
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Nlm Unique ID: 2985213R Medline TA: Lancet Country: England |
Other Details:
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Languages: eng Pagination: 340-5 Citation Subset: AIM; IM |
Copyright Information:
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Copyright 2010 Elsevier Ltd. All rights reserved. |
Affiliation:
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HIV Epidemiology and Biostatistics Group, Research Department of Infection and Population Health, UCL Medical School, Royal Free Campus, London, UK. r.lodwick@ucl.ac.uk |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adult Anti-HIV Agents / administration & dosage* Anti-Retroviral Agents / administration & dosage CD4 Lymphocyte Count* Cohort Studies Europe / epidemiology Female HIV Seropositivity / complications, drug therapy, immunology*, mortality* Hepatitis C / complications Humans International Cooperation Male Middle Aged North America / epidemiology Poisson Distribution Risk Assessment Risk Factors Viral Load |
| Grant Support | |
ID/Acronym/Agency:
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5-M01-RR-00052/RR/NCRR NIH HHS; U01 AI035039-19/AI/NIAID NIH HHS; U01 AI035040-16/AI/NIAID NIH HHS; U01 AI035041-17/AI/NIAID NIH HHS; U01 AI035042-17/AI/NIAID NIH HHS; U01 AI035043-19/AI/NIAID NIH HHS; U01-AI-35039/AI/NIAID NIH HHS; U01-AI-35040/AI/NIAID NIH HHS; U01-AI-35041/AI/NIAID NIH HHS; U01-AI-35042/AI/NIAID NIH HHS; U01-AI-35043/AI/NIAID NIH HHS; UL1 RR025005-05/RR/NCRR NIH HHS; //Medical Research Council |
| Chemical | |
Reg. No./Substance:
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0/Anti-HIV Agents; 0/Anti-Retroviral Agents |
| Investigator | |
Investigator/Affiliation:
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A Antoniadou / ; P Gargalianos-Kakolyris / ; O Katsarou / ; T Kordossis / ; M Lazanas / ; G Panos / ; V Paparizos / ; D Paraskevis / ; G Petrikkos / ; H Sambatakou / ; A Skoutelis / ; G Touloumi / ; G Touloumi / ; D Paraskevis / ; 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 Kauffmann / ; 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 / ; N Clumeck / ; S De Wit / ; 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 / ; M Prins / ; M Rosinska / ; C Sabin / ; G Touloumi / ; K Porter / ; S Lodi / ; K Coughlin / ; S Walker / ; A Babiker / ; H Bucher / ; A de Luca / ; M Fisher / ; R Muga / ; G Fätkenheuer / ; J Rockstroh / ; J-C Wasmuth / ; J Vehreschild / ; C Hertenstein / ; J Berenguer / ; J del Amo / ; F García / ; F Gutiérrez / ; P Labarga / ; S Moreno / ; M Angeles Muñoz / ; A M Caro-Murillo / ; P Sobrino / ; S Pérez-Cachafeiro / ; I Jarrín / ; B Alejos / ; M Angeles Muñoz / ; I García / ; J Gómez-Sirvent / ; V Soriano / ; F Pulido / ; J Iribarren / ; M Masiá / ; J Berenguer / ; F Vidal / ; J Sanz / ; J A Blanco / ; J Sola / ; S Moreno / ; F García / ; N Obel / ; J Gerstoft / ; G Kronborg / ; B Røge / ; C S Larsen / ; G Pedersen / ; A L Laursen / ; L Nielsen / ; J Jensen / ; E Babacan / ; M Bickel / ; A Bodtländer / ; H-R Brodt / ; A Carlebach / ; P Gute / ; A Haberl / ; E Helm / ; P Khaykin / ; S Klauke / ; G Knecht / ; T Lennemann / ; L Locher / ; T Lutz / ; M Mösch / ; A Müller / ; G Nisius / ; S Staszewski / ; C Stephan / ; M Stürmer / ; N von Hentig / ; T Wolf / ; J L Guest / ; D Rimland / ; A Moanna / ; M Moorfield / ; M Dorsey / ; K E Desilva / ; S Schlueter Wirtz / ; R Mindley / ; R Dozier / ; Y Robinson / ; P Brown / ; M Moroni / ; G Angarano / ; A Antinori / ; G Carosi / ; R Cauda / ; A d'Arminio Monforte / ; G Di Perri / ; M Galli / ; G Ghinelli / ; R Iardino / ; G Ippolito / ; A Lazzarin / ; F Mazzotta / ; C F Perno / ; P L Viale / ; F Von Schlosser / ; A Ammassari / ; A Antinori / ; C Balotta / ; P Bonfanti / ; M R Capobianchi / ; A Castagna / ; F Ceccherini-Silberstein / ; A Cozzi-Lepri / ; A d'Arminio Monforte / ; A De Luca / ; C Gervasoni / ; E Girardi / ; S Lo Caputo / ; F Maggiolo / ; R Murri / ; C Mussini / ; M Puoti / ; C Torti / ; A Castagna / ; S Salpietro / ; M Marangione / ; L Galli / ; A Lazzarin / ; N Gianotti / ; F Cossarini / ; V Spagnuolo / ; G Arendt / ; N H Brockmeyer / ; S Esser / ; A Haberl / ; H Jäger / ; S Schwarze / ; M Stoll / ; H Wolf / ; K Jansen / ; C Michalik / ; A Skaletz-Rorowski / ; C Königs / ; A Gingelmaier / ; J B Margolick / ; L P Jacobson / ; J P Phair / ; S M Wolinsky / ; R Detels / ; C R Rinaldo / ; C Boirot / ; A D Bouhnik / ; M P Carrieri / ; J P Cassuto / ; M Chesney / ; J Cohen / ; P Dellamonica / ; P Dujardin / ; H Gallais / ; J A Gastaut / ; P Kurkdji / ; G Lepeu / ; D Mechali / ; J P Moatti / ; J Moreau / ; M Nègre / ; Y Obadia / ; I Poizot-Martin / ; C Pradier / ; M Préau / ; D Rey / ; P Roux / ; C Rouzioux / ; A Sobel / ; B Spire / ; F Trémolières / ; V Villes / ; E Vincent / ; D Vlahov / ; C Mussini / ; V Borghi / ; J Casabona / ; J M Miró / ; J M Gatell / ; M López-Dieguez-Puerta / ; C Tural / ; B Clotet / ; D Podzamczer / ; E Ferrer / ; M Riera / ; J Murillas / ; F Segura / ; G Navarro / ; L Force / ; J Vilaró / ; A Masabeu / ; I García / ; M Guadarrama / ; A J Betancourt / ; A Romero / ; C Agustí / ; John Gill / ; M Battegay / ; E Bernasconi / ; J Böni / ; H C Bucher / ; P Bürgisser / ; A Calmy / ; M Cavassini / ; R Dubs / ; M Egger / ; L Elzi / ; M Fischer / ; M Flepp / ; A Fontana / ; P Francioli / ; H Furrer / ; C A Fux / ; M Gorgievski / ; H F Günthard / ; H H Hirsch / ; B Hirschel / ; I Hösli / ; C Kahlert / ; L Kaiser / ; U Karrer / ; C Kind / ; T Klimkait / ; B Ledergerber / ; G Martinetti / ; B Martinez / ; N Müller / ; D Nadal / ; F Paccaud / ; G Pantaleo / ; A Rauch / ; S Regenass / ; M Rickenbach / ; C Rudin / ; P Schmid / ; D Schultze / ; F Schöni / ; J Schüpbach / ; R Speck / ; P Taffé / ; A Telenti / ; A Trkola / ; P Vernazza / ; R Weber / ; S Yerly / ; J Ainsworth / ; J Anderson / ; A Babiker / ; V Delpech / ; D Dunn / ; P Easterbrook / ; M Fisher / ; B Gazzard / ; R Gilson / ; M Gompels / ; T Hill / ; M Johnson / ; C Leen / ; M Nelson / ; C Orkin / ; A Palfreeman / ; A Phillips / ; D Pillay / ; K Porter / ; F Post / ; C Sabin / ; A Schwenk / ; J Walsh / ; C Sabin / ; L Bansi / ; T Hill / ; A Phillips / ; S Huntington / ; D Dunn / ; A Glabay / ; K Porter / ; K Anastos / ; H Minkoff / ; M Young / ; R Greenblatt / ; A Levine / ; M Cohen / ; S Gange / |
| Comments/Corrections | |
Comment In:
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Lancet. 2010 Jul 31;376(9738):306-8
[PMID:
20638117
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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