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Poor CD4 response despite viral suppression is associated with increased non-AIDS-related mortality among HIV patients and their parents

Helleberg, Mariea,b; Kronborg, Gittec; Larsen, Carsten S.d; Pedersen, Gittee; Pedersen, Courtf; Obel, Nielsa; Gerstoft, Jana

doi: 10.1097/QAD.0b013e32835cba4c
Epidemiology and Social: CONCISE COMMUNICATION

Introduction: Poor CD4 response to antiretroviral treatment (HAART) is associated with increased mortality. We analyzed the impact of CD4 increase on non-AIDS-related morbidity and on mortality in HIV patients and their parents.

Methods: Mortality rates were estimated among 1758 virally suppressed patients in the Danish HIV Cohort Study after 2 years on HAART and among their parents (n = 1603). Analyses were stratified by pre-HAART CD4 count and CD4 increase. Incidence rate ratios (IRRs) of non-AIDS-related morbidity and mortality rate ratios (MRR) were analyzed using Poisson regression.

Results: CD4 increases less than 25 vs. more than 100 cells/μl was associated with increased mortality [MRR 3.5 (95% confidence interval (CI) 1.8–6.8)] even in individuals with pre-HAART CD4 cell count more than 250 cells/μl (MRR 3.2 (95%CI, 1.3–7.8). Mortality of parents of patients with poor CD4 response was also increased [MRR 1.5 (95%CI, 1.1–2.1)]. There was a trend towards association between poor CD4 response and increased risk of cardiovascular disease and cancer [IRR 1.6 (95%CI, 0.8–3.2) and 1.6 (95%CI, 0.6–4.8)].

Conclusion: Poor CD4 increase post-HAART is associated with adverse prognosis even in absence of severe immunosuppression. CD4 response in HIV patients is associated with mortality among their parents, thus poor CD4 response may be caused by genetic factors, which might also affect morbidity and mortality in the HIV-negative population.

aDepartment of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet

bFaculty of Health Sciences, Copenhagen University, Copenhagen

cDepartment of Infectious Diseases, Copenhagen University Hospital, Hvidovre

dDepartment of Infectious Diseases, Aarhus University Hospital, Aarhus

eDepartment of Infectious Diseases, Aalborg University Hospital, Aalborg

fDepartment of Infectious Diseases, Odense University Hospital, Odense, Denmark.

Correspondence to Dr Marie Helleberg, Department of Infectious Diseases, Rigshospitalet, Blegdamsvej 9, DK2100 Copenhagen, Denmark. Tel: +45 35457726; fax: +45 35456648; e-mail: mariehelleberg@sund.ku.dk

Received 15 September, 2012

Revised 30 October, 2012

Accepted 16 November, 2012

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© 2013 Lippincott Williams & Wilkins, Inc.