Mortality according to CD4 count at start of combination antiretroviral therapy among HIV positive patients followed for up to 15 years after start of treatment: collaborative cohort study. Clinical Infectious Diseases
May et al. on behalf of the Antiretroviral Therapy Cohort Collaboration estimated mortality rates by time since start of combination antiretroviral treatment (cART) among patients from 18 European and North American cohorts who started ART during 1996-2001. Median follow-up time was 11.3 years. During the first year of ART, there was a strong inverse association of CD4 count at start of ART with mortality. This diminished over the next 4 years. Overall mortality per 1000 person-years declined from 33 during the first 6 months of ART to 14 among those who survived 10 years from start of ART. After adjusting for other prognostic factors, the mortality rates ratios comparing baseline CD4 count
In conclusion, CD4 count at start of ART strongly predicts mortality rates during the first 5 years of ART. This finding reinforces the need for earlier diagnosis and treatment of people living with HIV. However, the burden of increased mortality associated with starting treatment late is alleviated for those who survive 5 years on ART.