CD4 counts and mortality in virologically suppressed US veterans

Area of Science:

• Immunology
• Epidemiology
• Public Health

Background:

• Human Immunodeficiency Virus (HIV) infection remains a significant public health concern.
• Highly Active Antiretroviral Therapy (HAART) has transformed HIV management, improving patient outcomes.
• Understanding factors influencing mortality in HIV-infected individuals on HAART is crucial for optimizing treatment strategies.

Purpose of the Study:

• To investigate the association between average CD4+ T-cell counts and all-cause mortality.
• To evaluate this association in HIV-infected veterans during their first episode of suppressive HAART.
• To inform clinical guidelines regarding the timing of HAART initiation.

Main Methods:

• Utilized the Veterans Health Administration (VA) HIV Clinical Case Registry (CCR).
• Analyzed data from 14,769 HIV-infected patients, observing 1083 deaths.
• Employed Cox proportional hazards models, controlling for covariates like demographics and co-infections.

Main Results:

• Mortality rates differed significantly across CD4+ T-cell count strata.
• Patients in the highest CD4+ quintile (≥720 cells/mm³) had lower mortality (14.1/1000 patient-years) compared to the next lower stratum.
• Higher CD4+ counts were associated with reduced all-cause mortality (HR: 1.4, CI: 1.13-1.73), even after adjusting for multiple factors.

Conclusions:

• Maintaining higher CD4+ T-cell counts during suppressive HAART is associated with reduced all-cause mortality in HIV-infected veterans.
• The findings support current US treatment guidelines advocating for early initiation of HAART.
• Optimizing HAART adherence and managing co-infections are vital for improving long-term survival in this population.