Mortality in Patients with Successful Initial Response to HAART
Is Still Higher Than in Non-HIV-infected Individuals
In the HAART era, mortality
among HIV positive individuals has decreased significantly.
It is well known that that the CD4+ T-cell count
and HIV RNA level at initiation of HAART are strong predictors of
disease outcome. In a collaborative study, researchers in the Netherlands
showed that baseline CD4 counts and viral load are not significantly
associated with prognosis once the initial response to HAART as
reflected in the 6-month CD4 cell counts and RNA levels are taken
into account.
In
the current study, the investigators analyzed progression to death
in a population of 3678 antiretroviral treatment-naive patients
from the ATHENA national observational cohort from 24 weeks after
the start of HAART.
Results
Mortality was compared with that
in the general population in the Netherlands matched by age and gender.
Only CD4 cell count and plasma viral load measured at 24 weeks
and infection via intravenous
drug use (IDU) were significantly associated with
progression to death.
For
non-IDU patients with 600 x 106 CD4 cells/L and an HIV RNA level
<100,000 copies/mL at 24 weeks, mortality was predicted to be 5.3 times higher
than in the general population for 25-year-old men and women,
respectively, and 1.15 and 1.29 times higher for 65-year-old men
and women, respectively.
Based
on these results, the authors conclude “Mortality in non-IDU HIV-infected
individuals who respond well to HAART….is still higher than in
the general population in the Netherlands. The
higher mortality in the HIV-infected population compared with
that in the general population decreases with older age and higher
CD4 cell counts in women and men.”
“The
absolute increase in mortality in the HIV-infected population,
however, is almost independent of age and gender.”
From the Virology Laboratory, Laboratory of Reproductive
Biology, Université René Descartes,
Hepatology
Service, Genetics Service (CECOS), Hospital Necker-Enfants
Malades, Paris,
France.
10/19/05
Reference
A van Sighem
and others (The ATHENA National Observational Cohort Study). Mortality in Patients With Successful Initial Response
to Highly Active Antiretroviral Therapy Is Still Higher Than in
Non-HIV-Infected Individuals. Journal of Acquired Immune Deficiency
Syndromes 40(2): 212-218, October 1, 2005.
