CD4+ count and risk of non-AIDS diseases following initial treatment for HIV infection

Jason V. Baker, Grace Peng, Joshua Rapkin, Donald I. Abrams, Michael J. Silverberg, Rodger David MacArthur, Winston P. Cavert, W. Keith Henry, James D. Neaton

Research output: Contribution to journalArticle

263 Citations (Scopus)

Abstract

BACKGROUND: Reductions in AIDS-related morbidity and mortality following the advent of combination antiretroviral therapy have coincided with relative increases in chronic non-AIDS end-organ diseases among HIV+ patients. OBJECTIVE: To examine the association of latest CD4+ counts with risk of non-AIDS diseases in a cohort of 1397 patients who initiate antiretroviral therapy. METHODS: CD4+ counts and HIV RNA levels along with fatal, and non-fatal, AIDS and non-AIDS diseases (liver, cardiovascular, renal, and cancer) were assessed over a median follow-up of 5 years. Cox proportional regression models were used to study risk associations. RESULTS: A total of 227 patients experienced an AIDS event and 80 patients developed a non-AIDS disease event. Both AIDS and non-AIDS diseases rates (events/100 person-years), respectively, declined with higher latest CD4+ counts: 13.8 and 2.1 with latest CD4+ counts less than 200 cells/μl; 2.0 and 1.7 for counts of 200-350 cells/μl; and 0.7 and 0.7 for counts greater than 350 cells/μl. After adjusting for baseline covariates and the latest HIV RNA level, risk of AIDS and non-AIDS diseases were lowered by 44% (95% confidence interval for hazard ratio 0.50-0.62, P < 0.01) and 14% (95% confidence interval for hazard ratio 0.77-0.96, P = 0.01), respectively, for each 100 cell/μl higher latest CD4+ count. CONCLUSION: Higher CD4+ counts on antiretroviral therapy are associated with lower rates of non-AIDS diseases and AIDS. These findings expand our understanding of the implications of HIV-related immunodeficiency and motivate randomized studies to evaluate the effects of antiretroviral therapy on a broad set of clinical outcomes at CD4+ counts greater than 350 cells/μl.

Original languageEnglish (US)
Pages (from-to)841-848
Number of pages8
JournalAIDS
Volume22
Issue number7
DOIs
StatePublished - Apr 1 2008

Fingerprint

CD4 Lymphocyte Count
HIV Infections
Acquired Immunodeficiency Syndrome
HIV
Therapeutics
RNA
Confidence Intervals
Kidney Neoplasms
Liver Diseases
Cardiovascular Diseases
Morbidity
Mortality

Keywords

  • AIDS
  • Antiretroviral therapy
  • CD4 count
  • HIV morbidity and mortality
  • Non-AIDS conditions

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Infectious Diseases

Cite this

Baker, J. V., Peng, G., Rapkin, J., Abrams, D. I., Silverberg, M. J., MacArthur, R. D., ... Neaton, J. D. (2008). CD4+ count and risk of non-AIDS diseases following initial treatment for HIV infection. AIDS, 22(7), 841-848. https://doi.org/10.1097/QAD.0b013e3282f7cb76

CD4+ count and risk of non-AIDS diseases following initial treatment for HIV infection. / Baker, Jason V.; Peng, Grace; Rapkin, Joshua; Abrams, Donald I.; Silverberg, Michael J.; MacArthur, Rodger David; Cavert, Winston P.; Henry, W. Keith; Neaton, James D.

In: AIDS, Vol. 22, No. 7, 01.04.2008, p. 841-848.

Research output: Contribution to journalArticle

Baker, JV, Peng, G, Rapkin, J, Abrams, DI, Silverberg, MJ, MacArthur, RD, Cavert, WP, Henry, WK & Neaton, JD 2008, 'CD4+ count and risk of non-AIDS diseases following initial treatment for HIV infection', AIDS, vol. 22, no. 7, pp. 841-848. https://doi.org/10.1097/QAD.0b013e3282f7cb76
Baker, Jason V. ; Peng, Grace ; Rapkin, Joshua ; Abrams, Donald I. ; Silverberg, Michael J. ; MacArthur, Rodger David ; Cavert, Winston P. ; Henry, W. Keith ; Neaton, James D. / CD4+ count and risk of non-AIDS diseases following initial treatment for HIV infection. In: AIDS. 2008 ; Vol. 22, No. 7. pp. 841-848.
@article{5645ccde46b7435d9d0e9efaed838570,
title = "CD4+ count and risk of non-AIDS diseases following initial treatment for HIV infection",
abstract = "BACKGROUND: Reductions in AIDS-related morbidity and mortality following the advent of combination antiretroviral therapy have coincided with relative increases in chronic non-AIDS end-organ diseases among HIV+ patients. OBJECTIVE: To examine the association of latest CD4+ counts with risk of non-AIDS diseases in a cohort of 1397 patients who initiate antiretroviral therapy. METHODS: CD4+ counts and HIV RNA levels along with fatal, and non-fatal, AIDS and non-AIDS diseases (liver, cardiovascular, renal, and cancer) were assessed over a median follow-up of 5 years. Cox proportional regression models were used to study risk associations. RESULTS: A total of 227 patients experienced an AIDS event and 80 patients developed a non-AIDS disease event. Both AIDS and non-AIDS diseases rates (events/100 person-years), respectively, declined with higher latest CD4+ counts: 13.8 and 2.1 with latest CD4+ counts less than 200 cells/μl; 2.0 and 1.7 for counts of 200-350 cells/μl; and 0.7 and 0.7 for counts greater than 350 cells/μl. After adjusting for baseline covariates and the latest HIV RNA level, risk of AIDS and non-AIDS diseases were lowered by 44{\%} (95{\%} confidence interval for hazard ratio 0.50-0.62, P < 0.01) and 14{\%} (95{\%} confidence interval for hazard ratio 0.77-0.96, P = 0.01), respectively, for each 100 cell/μl higher latest CD4+ count. CONCLUSION: Higher CD4+ counts on antiretroviral therapy are associated with lower rates of non-AIDS diseases and AIDS. These findings expand our understanding of the implications of HIV-related immunodeficiency and motivate randomized studies to evaluate the effects of antiretroviral therapy on a broad set of clinical outcomes at CD4+ counts greater than 350 cells/μl.",
keywords = "AIDS, Antiretroviral therapy, CD4 count, HIV morbidity and mortality, Non-AIDS conditions",
author = "Baker, {Jason V.} and Grace Peng and Joshua Rapkin and Abrams, {Donald I.} and Silverberg, {Michael J.} and MacArthur, {Rodger David} and Cavert, {Winston P.} and Henry, {W. Keith} and Neaton, {James D.}",
year = "2008",
month = "4",
day = "1",
doi = "10.1097/QAD.0b013e3282f7cb76",
language = "English (US)",
volume = "22",
pages = "841--848",
journal = "AIDS",
issn = "0269-9370",
publisher = "Lippincott Williams and Wilkins",
number = "7",

}

TY - JOUR

T1 - CD4+ count and risk of non-AIDS diseases following initial treatment for HIV infection

AU - Baker, Jason V.

AU - Peng, Grace

AU - Rapkin, Joshua

AU - Abrams, Donald I.

AU - Silverberg, Michael J.

AU - MacArthur, Rodger David

AU - Cavert, Winston P.

AU - Henry, W. Keith

AU - Neaton, James D.

PY - 2008/4/1

Y1 - 2008/4/1

N2 - BACKGROUND: Reductions in AIDS-related morbidity and mortality following the advent of combination antiretroviral therapy have coincided with relative increases in chronic non-AIDS end-organ diseases among HIV+ patients. OBJECTIVE: To examine the association of latest CD4+ counts with risk of non-AIDS diseases in a cohort of 1397 patients who initiate antiretroviral therapy. METHODS: CD4+ counts and HIV RNA levels along with fatal, and non-fatal, AIDS and non-AIDS diseases (liver, cardiovascular, renal, and cancer) were assessed over a median follow-up of 5 years. Cox proportional regression models were used to study risk associations. RESULTS: A total of 227 patients experienced an AIDS event and 80 patients developed a non-AIDS disease event. Both AIDS and non-AIDS diseases rates (events/100 person-years), respectively, declined with higher latest CD4+ counts: 13.8 and 2.1 with latest CD4+ counts less than 200 cells/μl; 2.0 and 1.7 for counts of 200-350 cells/μl; and 0.7 and 0.7 for counts greater than 350 cells/μl. After adjusting for baseline covariates and the latest HIV RNA level, risk of AIDS and non-AIDS diseases were lowered by 44% (95% confidence interval for hazard ratio 0.50-0.62, P < 0.01) and 14% (95% confidence interval for hazard ratio 0.77-0.96, P = 0.01), respectively, for each 100 cell/μl higher latest CD4+ count. CONCLUSION: Higher CD4+ counts on antiretroviral therapy are associated with lower rates of non-AIDS diseases and AIDS. These findings expand our understanding of the implications of HIV-related immunodeficiency and motivate randomized studies to evaluate the effects of antiretroviral therapy on a broad set of clinical outcomes at CD4+ counts greater than 350 cells/μl.

AB - BACKGROUND: Reductions in AIDS-related morbidity and mortality following the advent of combination antiretroviral therapy have coincided with relative increases in chronic non-AIDS end-organ diseases among HIV+ patients. OBJECTIVE: To examine the association of latest CD4+ counts with risk of non-AIDS diseases in a cohort of 1397 patients who initiate antiretroviral therapy. METHODS: CD4+ counts and HIV RNA levels along with fatal, and non-fatal, AIDS and non-AIDS diseases (liver, cardiovascular, renal, and cancer) were assessed over a median follow-up of 5 years. Cox proportional regression models were used to study risk associations. RESULTS: A total of 227 patients experienced an AIDS event and 80 patients developed a non-AIDS disease event. Both AIDS and non-AIDS diseases rates (events/100 person-years), respectively, declined with higher latest CD4+ counts: 13.8 and 2.1 with latest CD4+ counts less than 200 cells/μl; 2.0 and 1.7 for counts of 200-350 cells/μl; and 0.7 and 0.7 for counts greater than 350 cells/μl. After adjusting for baseline covariates and the latest HIV RNA level, risk of AIDS and non-AIDS diseases were lowered by 44% (95% confidence interval for hazard ratio 0.50-0.62, P < 0.01) and 14% (95% confidence interval for hazard ratio 0.77-0.96, P = 0.01), respectively, for each 100 cell/μl higher latest CD4+ count. CONCLUSION: Higher CD4+ counts on antiretroviral therapy are associated with lower rates of non-AIDS diseases and AIDS. These findings expand our understanding of the implications of HIV-related immunodeficiency and motivate randomized studies to evaluate the effects of antiretroviral therapy on a broad set of clinical outcomes at CD4+ counts greater than 350 cells/μl.

KW - AIDS

KW - Antiretroviral therapy

KW - CD4 count

KW - HIV morbidity and mortality

KW - Non-AIDS conditions

UR - http://www.scopus.com/inward/record.url?scp=42449086328&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=42449086328&partnerID=8YFLogxK

U2 - 10.1097/QAD.0b013e3282f7cb76

DO - 10.1097/QAD.0b013e3282f7cb76

M3 - Article

VL - 22

SP - 841

EP - 848

JO - AIDS

JF - AIDS

SN - 0269-9370

IS - 7

ER -