Immunodeficiency and the Risk of Death in HIV Infection

Phillips, Andrew

doi:10.1001/jama.1992.03490190062032

Cited by 45 publications

(6 citation statements)

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“…The second largest group had CD4 counts of above 350 cells/µL (26%). Although those with a CD4 count of <50 cells/µL represented 24% of the cohort, 62% of deaths were in this group of patients, indicating high morbidity and mortality associated with low CD4 counts, which has been previously reported (7). …”

Section: Discussionsupporting

confidence: 72%

Clinical Profile of HIV/AIDS-infected Patients Admitted to a New Specialist Unit in Dhaka, Bangladesh - A Low-prevalence Country for HIV

Matin

Shahrin

Pervez

et al. 2011

J Health Popul Nutr

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This paper describes the clinical features of a series of patients admitted to the specialist HIV/AIDS unit (Jagori) of the Dhaka Hospital, ICDDR, B (International Centre for Diarrhoeal Disease Research, Bangladesh) during May 2008–February 2010. Data were collected from a review of documents and electronic case-records and collation of laboratory results with respect to CD4 counts. One hundred and nine patients were admitted during this period. Their mean age was 33.4 years, and 62% were male. On admission, the mean CD4 count±standard deviation (SD) was 244±245 (range 2-1, 549). The death rate was 12%. The patients were classified as World Health Organization clinical stage 1: 23%, stage 2: 30%, stage 3: 23%, and stage 4: 24% during the admission. The commonest diagnosis recorded was tuberculosis (TB) (23%), which was also the commonest cause of death (38%). Even for those clinicians with limited experience of managing AIDS cases, the commonest problem encountered in this patient group was TB, reflecting the continued high burden of TB on health services in Bangladesh. Additional challenges to managing TB/HIV co-infection include atypical presentations in HIV-infected persons and the complex drug interaction with antiretroviral therapy.

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Section: Discussionsupporting

confidence: 72%

Clinical Profile of HIV/AIDS-infected Patients Admitted to a New Specialist Unit in Dhaka, Bangladesh - A Low-prevalence Country for HIV

Matin

Shahrin

Pervez

et al. 2011

J Health Popul Nutr

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“…Mortality among HIV-infected individuals is much higher than in the general population (1–3) with the risk of death increasing as the CD4 cell count declines (4). Antiretroviral therapy (ART) is currently the most effective intervention for reducing mortality among HIV-infected individuals.…”

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confidence: 99%

Mortality and its predictors among antiretroviral therapy naïve HIV-infected individuals with CD4 cell count ≥350 cells/mm ³ compared to the general population: data from a population-based prospective HIV cohort in Uganda

Masiira

Baisley

Mayanja

et al. 2014

Global Health Action

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BackgroundEvidence exists that even at high CD4 counts, mortality among HIV-infected antiretroviral therapy (ART) naïve individuals is higher than that in the general population. However, many developing countries still initiate ART at CD4 ≤350 cells/mm3.ObjectiveTo compare mortality among HIV-infected ART naïve individuals with CD4 counts ≥350 cells/mm3 with mortality in the general Ugandan population and to investigate risk factors for death.DesignPopulation-based prospective HIV cohort.MethodsThe study population consisted of HIV-infected people in rural southwest Uganda. Patients were reviewed at the study clinic every 3 months. CD4 cell count was measured every 6 months. Rate ratios were estimated using Poisson regression. Indirect methods were used to calculate standardised mortality ratios (SMRs).ResultsA total of 374 participants with CD4 ≥350 cells/mm3 were followed for 1,328 person-years (PY) over which 27 deaths occurred. Mortality rates (MRs) (per 1,000 PY) were 20.34 (95% CI: 13.95–29.66) among all participants and 16.43 (10.48–25.75) among participants aged 15–49 years. Mortality was higher in periods during which participants had CD4 350–499 cells/mm3 than during periods of CD4 ≥500 cells/mm3 although the difference was not statistically significant [adjusted rate ratio (aRR)=1.52; 95% CI: 0.71–3.25]. Compared to the general Ugandan population aged 15–49 years, MRs were 123% higher among participants with CD4 ≥500 cells/mm3 (SMR: 223%, 95% CI: 127–393%) and 146% higher among participants with CD4 350–499 cells/mm3 (246%, 117%–516). After adjusting for current age, mortality was associated with increasing WHO clinical stage (aRR comparing stage 3 or 4 and stage 1: 10.18, 95% CI: 3.82–27.15) and decreasing body mass index (BMI) (aRR comparing categories ≤17.4 Kg/m2 and ≥18.5 Kg/m2: 6.11, 2.30–16.20).ConclusionHIV-infected ART naïve individuals with CD4 count ≥350 cells/mm3 had a higher mortality than the general population. After adjusting for age, the main predictors of mortality were WHO clinical stage and BMI.

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“…HIV-1-related mortality increases as the CD4 count in peripheral blood decreases [1]. Initiation of antiretroviral therapy (ART) at a CD4 count above 200 cells/μl reduces mortality of HIV-1 infected persons compared to therapy that is delayed until CD4 count declines below 200 cells/μl [2], and adopting an even higher CD4 threshold for initiating ART may further reduce mortality [3-5].…”

Section: Introductionmentioning

confidence: 99%

Mortality in members of HIV-1 serodiscordant couples in Africa and implications for antiretroviral therapy initiation: Results of analyses from a multicenter randomized trial

et al. 2012

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BackgroundThe risk of HIV-1 related mortality is strongly related to CD4 count. Guidance on optimal timing for initiation of antiretroviral therapy (ART) is still evolving, but the contribution of HIV-1 infection to excess mortality at CD4 cell counts above thresholds for HIV-1 treatment has not been fully described, especially in resource-poor settings. To compare mortality among HIV-1 infected and uninfected members of HIV-1 serodiscordant couples followed for up to 24 months, we conducted a secondary data analysis examining mortality among HIV-1 serodiscordant couples participating in a multicenter, randomized controlled trial at 14 sites in seven sub-Saharan African countries.MethodsPredictors of death were examined using Cox regression and excess mortality by CD4 count and plasma HIV-1 RNA was computed using Poisson regression for correlated data.ResultsAmong 3295 HIV serodiscordant couples, we observed 109 deaths from any cause (74 deaths among HIV-1 infected and 25 among HIV-1 uninfected persons). Among HIV-1 infected persons, the risk of death increased with lower CD4 count and higher plasma viral levels. HIV-1 infected persons had excess mortality due to medical causes of 15.2 deaths/1000 person years at CD4 counts of 250 – 349 cells/μl and 8.9 deaths at CD4 counts of 350 – 499 cells/μl. Above a CD4 count of 500 cells/μl, mortality was comparable among HIV-1 infected and uninfected persons.ConclusionsAmong African serodiscordant couples, there is a high rate of mortality attributable to HIV-1 infection at CD4 counts above the current threshold (200 – 350 cells/μl) for ART initiation in many African countries. These data indicate that earlier initiation of treatment is likely to provide clinical benefit if further expansion of ART access can be achieved.Trial RegistrationClinicaltrials.gov (NCT00194519)

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Immunodeficiency and the Risk of Death in HIV Infection

Abstract: In patients with HIV infection who are closely followed up, the risk of death is low before the CD4 lymphocyte count has fallen to 0.05 x 10(9)/L, a count many patients remain above up to 12 years after seroconversion.

Cited by 45 publications

References 21 publications

Clinical Profile of HIV/AIDS-infected Patients Admitted to a New Specialist Unit in Dhaka, Bangladesh - A Low-prevalence Country for HIV

Clinical Profile of HIV/AIDS-infected Patients Admitted to a New Specialist Unit in Dhaka, Bangladesh - A Low-prevalence Country for HIV

Mortality and its predictors among antiretroviral therapy naïve HIV-infected individuals with CD4 cell count ≥350 cells/mm ³ compared to the general population: data from a population-based prospective HIV cohort in Uganda

Mortality in members of HIV-1 serodiscordant couples in Africa and implications for antiretroviral therapy initiation: Results of analyses from a multicenter randomized trial

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Immunodeficiency and the Risk of Death in HIV Infection

Abstract: In patients with HIV infection who are closely followed up, the risk of death is low before the CD4 lymphocyte count has fallen to 0.05 x 10(9)/L, a count many patients remain above up to 12 years after seroconversion.

Cited by 45 publications

References 21 publications

Clinical Profile of HIV/AIDS-infected Patients Admitted to a New Specialist Unit in Dhaka, Bangladesh - A Low-prevalence Country for HIV

Clinical Profile of HIV/AIDS-infected Patients Admitted to a New Specialist Unit in Dhaka, Bangladesh - A Low-prevalence Country for HIV

Mortality and its predictors among antiretroviral therapy naïve HIV-infected individuals with CD4 cell count ≥350 cells/mm 3 compared to the general population: data from a population-based prospective HIV cohort in Uganda

Mortality in members of HIV-1 serodiscordant couples in Africa and implications for antiretroviral therapy initiation: Results of analyses from a multicenter randomized trial

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Mortality and its predictors among antiretroviral therapy naïve HIV-infected individuals with CD4 cell count ≥350 cells/mm ³ compared to the general population: data from a population-based prospective HIV cohort in Uganda