Patients with below-normal CD4+ cell counts (350 to 499 cells/mm3) were at elevated risk of death. Based on the standardized mortality ratio, the risk of death in this group was 77 percent higher than in the general population.
With Normal CD4+ Cell Counts, No Increase in Mortality
However, in HIV-infected patients with a CD4+ cell count of 500 cells/mm3 or higher, the risk of death was not significantly higher than in the general population. For this group, the risk of death was essentially normal regardless of how low the CD4+ cell count dipped during treatment, as long as it returned to normal.
Over the years, effective ART regimens for HIV infection have become simpler, less toxic, and more effective. "Due to the success of ART, it is relevant to ask if death rates in optimally treated HIV are higher than the general population," the researchers write.
Previous studies have suggested that, with successful treatment, mortality risk approaches that of people without HIV. However, these studies have had important limitations, including a lack of complete information on patient outcomes. The use of comprehensive follow-up data from the ESPRIT and SMART trials overcomes this limitation.
The new study provides the best evidence yet that, with effective ART that achieving good disease control, the mortality rate for people with HIV is essentially the same as in the general population. Dr Rodger and colleagues conclude, "Our data support the importance of early diagnosis and treatment to improve clinical outcomes and it is likely that much of the excess mortality associated with HIV would be preventable with timely diagnosis of HIV and initiation of ART."
Further studies will be needed to clarify the implications for HIV treatment, including the best time to start ART based o
|Contact: Connie Hughes|
Wolters Kluwer Health