A Lower CD4 Count Predicts Most Causes of Death except Cardiovascular Deaths. The Austrian HIV Cohort Study

Gisela Leierer, Armin Rieger, Brigitte Schmied, Mario Sarcletti, Angela Öllinger, Elmar Wallner, Alexander Egle, Manfred Kanatschnig, Alexander Zoufaly, Michele Atzl, Michaela Rappold, Ziad El-Khatib, Bruno Ledergerber, Robert Zangerle and on behalf of the Austrian HIV Cohort Study Group
Additional contact information
Gisela Leierer: Department of Dermatology and Venereology, Medical University of Innsbruck, 6020 Innsbruck, Austria
Armin Rieger: Division of Immunology, Allergy and Infectious Diseases, Department of Dermatology, Medical University of Vienna, 1090 Vienna, Austria
Brigitte Schmied: Otto-Wagner Hospital, 1140 Vienna, Austria
Mario Sarcletti: Department of Dermatology and Venereology, Medical University of Innsbruck, 6020 Innsbruck, Austria
Angela Öllinger: Department of Dermatology, Med. Campus III, Kepler University Hospital Linz, Johannes Kepler University Linz, 4040 Linz, Austria
Elmar Wallner: Department of Internal Medicine, General Hospital Graz South-West, 8020 Graz, Austria
Alexander Egle: Department of Internal Medicine III with Hematology, Medical Oncology, Hemostaseology, Infectious Diseases, Rheumatology, Oncologic Center, Laboratory for Immunological and Molecular Cancer Research, Paracelsus Medical University, 5020 Salzburg, Austria
Manfred Kanatschnig: 1st Medical Department, General Hospital Klagenfurt, 9020 Klagenfurt, Austria
Alexander Zoufaly: Kaiser-Franz-Josef Hospital Vienna, 1100 Vienna, Austria
Michele Atzl: Department of Internal Medicine, Oncology, Haematology, Infectious Diseases, State Hospital Feldkirch, 6800 Feldkirch, Austria
Michaela Rappold: Department of Dermatology and Venereology, Medical University of Innsbruck, 6020 Innsbruck, Austria
Ziad El-Khatib: Department of Surveillance and Infectious Disease Epidemiology, Austrian Agency for Health and Food Safety (AGES), Austrian Ministry for Health, Ministry of Sustainability and Tourism, 1220 Vienna, Austria
Bruno Ledergerber: Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, 8006 Zurich, Switzerland
Robert Zangerle: Department of Dermatology and Venereology, Medical University of Innsbruck, 6020 Innsbruck, Austria
on behalf of the Austrian HIV Cohort Study Group: Collaborators of the Austrian HIV Cohort Study Group are indicated in the Acknowledgment section.

IJERPH, 2021, vol. 18, issue 23, 1-12

Abstract: (1) Objective: To investigate changes in mortality rates and predictors of all-cause mortality as well as specific causes of death over time among HIV-positive individuals in the combination antiretroviral therapy (cART) era. (2) Methods: We analyzed all-cause as well as cause-specific mortality among the Austrian HIV Cohort Study between 1997 and 2014. Observation time was divided into five periods: Period 1: 1997–2000; period 2: 2001–2004; period 3: 2005–2008; period 4: 2009–2011; and period 5: 2012–2014. Mortality rates are presented as deaths per 100 person-years (d/100py). Potential risk factors associated with all-cause mortality and specific causes of death were identified by using multivariable Cox proportional hazard models. Models were adjusted for time-updated CD4, age and cART, HIV transmission category, population size of residence area and country of birth. To assess potential nonlinear associations, we fitted all CD4 counts per patient using restricted cubic splines with truncation at 1000 cells/mm 3 . Vital status of patients was cross-checked with death registry data. (3) Results: Of 6848 patients (59,704 person-years of observation), 1192 died: 380 (31.9%) from AIDS-related diseases. All-cause mortality rates decreased continuously from 3.49 d/100py in period 1 to 1.40 d/100py in period 5. Death due to AIDS-related diseases, liver-related diseases and non-AIDS infections declined, whereas cardiovascular diseases as cause of death remained stable (0.27 d/100py in period 1, 0.10 d/100py in period 2, 0.16 d/100py in period 3, 0.09 d/100py in period 4 and 0.14 d/100py in period 5) and deaths due to non-AIDS-defining malignancies increased. Compared to latest CD4 counts of 500 cells/mm 3 , lower CD4 counts conferred a higher risk of deaths due to AIDS-related diseases, liver-related diseases, non-AIDS infections and non-AIDS-defining malignancies, whereas no significant association was observed for cardiovascular mortality. Results were similar in sensitivity analyses where observation time was divided into two periods: 1997–2004 and 2005–2014. (4) Conclusions: Since the introduction of cART, risk of death decreased and causes of death changed. We do not find evidence that HIV-positive individuals with a low CD4 count are more likely to die from cardiovascular diseases.

Keywords: cohort study; cause-specific mortality; CD4; cART; risk factors (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2021
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