Impact on life expectancy of HIV-1 positive individuals of CD4+ cell count and viral load response to antiretroviral therapy
Margaret T May,Mark Gompels,Valerie Delpech,Kholoud Porter,Chloe Orkin,Stephen Kegg,Phillip Hay,Margaret Johnson,Adrian Palfreeman,Richard Gilson,David R. Chadwick,Fabiola Martin,Teresa Hill,John Walsh,Frank A. Post,Martin Fisher,Jonathan Ainsworth,Sophie Jose,Clifford Leen,Mark Nelson,Jane Anderson,Caroline A. Sabin +21 more
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TLDR
Patients who started ART with a low CD4+ cell count significantly improve their life expectancy if they have a good CD4- cell count response and undetectable viral load.Abstract:
Objective: The objective of this study is to estimate life expectancies of HIV-positive patients conditional on response to antiretroviral therapy (ART). Methods: Patients aged more than 20 years who started ART during 2000-2010 (excluding IDU) in HIV clinics contributing to the UK CHIC Study were followed for mortality until 2012.Wedetermined the latestCD4+ cell count and viral load before ART and in each of years 1-5 of ART. For each duration of ART, life tables based on estimated mortality rates by sex, age, latest CD4+ cell count and viral suppression (HIV-1 RNA <400 copies/ml), were used to estimate expected age at death for ages 20-85 years. Results: Of 21 388 patients who started ART, 961 (4.5%) died during 110 697 personyears. At start of ART, expected age at death [95% confidence interval (CI)] of 35-yearold men with CD4+ cell count less than 200, 200-349, at least 350 cells/ml was 71 (68- 73), 78 (74-82) and 77 (72-81) years, respectively, compared with 78 years for men in the general UK population. Thirty-five-year-old men who increased their CD4+ cell count in the first year of ART from less than 200 to 200-349 or at least 350 cells/ml and achieved viral suppression gained 7 and 10 years, respectively. After 5 years on ART, expected age at death of 35-year-old men varied from 54 (48-61) (CD4+ cell count <200 cells/ml and no viral suppression) to 80 (76-83) years (CD4+ cell count 350 cells/ml and viral suppression). Conclusion: Successfully treated HIV-positive individuals have a normal life expectancy. Patients who started ART with a low CD4+ cell count significantly improve their life expectancy if they have a good CD4+ cell count response and undetectable viral load.read more
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References
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Robert S. Hogg,Viviane D. Lima,Jonathan A C Sterne,Sophie Grabar,Manuel Battegay,M. Bonarek,A d'Arminio Monforte,Anna Esteve,Michael Gill,RJ Harris,Amy C. Justice,A. Hayden,F Lampe,Amanda Mocroft,Jan-Christian Wasmuth,Michael J. Mugavero,S Staszewski,A.I. van Sighem,Mari M. Kitahata,Jodie L. Guest,M Egger,Margaret T May +21 more
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Antiretroviral therapy cohort collaboration : life expectancy of individuals on combination antiretroviral therapy in high-income countries: a collaborative analysis of 14 cohort studies
Robert S. Hogg,Viviane D. Lima,Jonathan A C Sterne,Sophie Grabar,Manuel Battegay,M. Bonarek,A d'Arminio Monforte,Anna Esteve,Michael Gill,RJ Harris,Amy C. Justice,A. Hayden,F Lampe,Amanda Mocroft,Michael J. Mugavero,S Staszewski,Jan-Christian Wasmuth,A.I. van Sighem,Mari M. Kitahata,Jodie L. Guest,M Egger,Margaret T May +21 more
TL;DR: In this article, the authors compared changes in mortality and life expectancy among HIV-positive individuals on combination antiretroviral therapy in 1996-99, 2000-02, and 2003-05, and stratified by sex, baseline CD4 cell count, and history of injecting drug use.
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