Mortality in Well Controlled HIV in the Continuous Antiretroviral Therapy Arms of the SMART and ESPRIT Trials Compared to the General Population

Mortality in Well Controlled HIV in the Continuous Antiretroviral Therapy Arms of the SMART and ESPRIT Trials Compared to the General Population

Online publication: 12/03/2013

Abstract:

Background: Due to the success of antiretroviral therapy (ART) it is relevant to ask if death rates in optimally treated HIV are higher than the general population. The objective was to compare mortality rates in well controlled HIV-infected adults in the SMART and ESPRIT clinical trials with the general population. Methods: Non-injecting drug users (IDU) aged 20-70 years from the continuous ART control arms of ESPRIT and SMART were included if the person had both low HIV plasma viral loads (VL, <= 400 c/ml SMART, <= 500 c/ml ESPRIT) and high CD4+ T cell counts (>= 350 cells/[mu]L) at any time in the past 6 months. Standardized mortality ratios (SMRs) were calculated by comparing death rates with the Human Mortality Database. Results: 3280 individuals (665 (20%) female), median age 43 years, contributed 12 357 person-years of follow-up. 62 deaths occurred during follow up. Commonest cause of death was CVD or sudden death (19, 31%), followed by non-AIDS malignancy (12, 19%). Only 2 deaths (3%) were AIDS-related. Mortality rate was increased compared to the general population with a CD4+ count between 350-499 cells/[mu]L, (SMR 1.77, 95% CI: 1.17, 2.55). No evidence for increased mortality was seen with CD4+ counts >=500 cells/[mu]L (SMR 1.00, 95% CI: 0.69, 1.40). Conclusions: In HIV-infected individuals on ART, with a recent undetectable VL, who maintained or had recovery of CD4+ counts to >=500 cells/[mu]L we identified no evidence for a raised risk of death compared to the general population. Read abstract online in AIDS (full article available in PDF for a limited time)

Authors:  Rodger, Alison1; Lodwick, Rebecca1; Schechter, Mauro2; Deeks, Steven3; Amin, Janaki4; Gilson, Richard1; Paredes, Roger5; Bakowska, Elzbieta6; Engsig, Frederik N.7; Phillips, Andrew1; for the INSIGHT SMART, ESPRIT Study Groups 1 University College London, London, UK 2 Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil 3 The University of California, San Francisco, CA, US 4 University of New South Wales, Sydney, Australia 5 IrsiCaixa AIDS Research Institute, Badalona, Spain 6 Wojewodzki Szpital Zakazny, Warsaw, Poland 7 Frederik N Engsig, Copenhagen University Hospital, Copenhagen, Denmark Read abstract online in AIDS (full article available in PDF for a limited time)
  • Doi Code: DOI:10.1097/QAD.0b013e32835cae9c

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