Article open access publication

Long-term Mortality in HIV-Positive Individuals Virally Suppressed for >3 Years With Incomplete CD4 Recovery

Clinical Infectious Diseases, Oxford University Press (OUP), ISSN 1058-4838

Volume 58, 9, 2014

DOI:10.1093/cid/ciu038, Dimensions: pub.1010992457, PMC: PMC6276895, PMID: 24457342,


Reiss, Peter (6) (7)
Kirk, Ole (2) (15)
Justice, Amy C. (34) (35)



  1. (1) State Serum Institute, grid.6203.7
  2. (2) Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital
  3. (3) Innsbruck Medical University, grid.5361.1
  4. (4) Laiko General Hospital of Athens, grid.411565.2
  5. (5) University of Bordeaux, grid.412041.2
  6. (6) Academic Medical Center, grid.5650.6
  7. (7) Stichting HIV Monitoring, grid.500326.2
  8. (8) University of Calgary, grid.22072.35
  9. (9) MRC Clinical Trials Unit, grid.415052.7
  10. (10) Research Department of Infection and Population Health, University College London
  11. (11) Alder Hey Children's NHS Foundation Trust, grid.417858.7
  12. (12) University of Cologne, grid.6190.e
  13. (13) Infectious Diseases Unit, Hospital General Universitario de Elche, Universidad Miguel Hernández, Alicante, Spain
  14. (14) Centre Hospitalier Universitaire de Nantes, grid.277151.7
  15. (15) University of Copenhagen, grid.5254.6, KU
  16. (16) L'Institut National de la Santé et de la Recherche Médicale (INSERM), Unité Mixte de Recherche en Santé 943, University Pierre and Marie Curie, Hospital Pitie-Salpetriere, Paris, France
  17. (17) University Hospital Frankfurt, grid.411088.4
  18. (18) Agencia de Salud Pública de Barcelona, grid.415373.7
  19. (19) Atlanta VA Medical Center, grid.414026.5
  20. (20) St. Paul's Hospital, grid.416553.0
  21. (21) Department of Infectious and Tropical Diseases, San Raffaele Scientific Institute
  22. (22) Ospedale San Paolo, grid.415093.a
  23. (23) Ruhr University Bochum, grid.5570.7
  24. (24) Hospital Universitario de Getafe, grid.411244.6
  25. (25) Azienda Ospedaliera San Gerardo, grid.415025.7
  26. (26) Hospital de Mataró, grid.414519.c
  27. (27) Bicêtre Hospital, grid.413784.d
  28. (28) University College London, grid.83440.3b
  29. (29) INSERM, CESP Centre for Research in Epidemiology and Population Health, Epidemiology of HIV and STI Team, Université Paris-Sud, Le Kremlin Bicêtre, France
  30. (30) University Hospital of Basel, grid.410567.1
  31. (31) Centre Hospitalier Universitaire de Saint-Pierre, grid.50545.31
  32. (32) University of Alabama at Birmingham, grid.265892.2
  33. (33) Servicio de Medicina Interna, Hospital de Sierrallana Torrelavega, Cantabria, Spain
  34. (34) VA Connecticut Healthcare System, grid.281208.1
  35. (35) Yale University, grid.47100.32
  36. (36) Vanderbilt University, grid.152326.1
  37. (37) University of Washington, grid.34477.33
  38. (38) University of Bristol, grid.5337.2


BACKGROUND: Some human immunodeficiency virus (HIV)-infected individuals initiating combination antiretroviral therapy (cART) with low CD4 counts achieve viral suppression but not CD4 cell recovery. We aimed to identify (1) risk factors for failure to achieve CD4 count >200 cells/µL after 3 years of sustained viral suppression and (2) the association of the achieved CD4 count with subsequent mortality. METHODS: We included treated HIV-infected adults from 2 large international HIV cohorts, who had viral suppression (≤500 HIV type 1 RNA copies/mL) for >3 years with CD4 count ≤200 cells/µL at start of the suppressed period. Logistic regression was used to identify risk factors for incomplete CD4 recovery (≤200 cells/µL) and Cox regression to identify associations with mortality. RESULTS: Of 5550 eligible individuals, 835 (15%) did not reach a CD4 count >200 cells/µL after 3 years of suppression. Increasing age, lower initial CD4 count, male heterosexual and injection drug use transmission, cART initiation after 1998, and longer time from initiation of cART to start of the virally suppressed period were risk factors for not achieving a CD4 count >200 cells/µL. Individuals with CD4 ≤200 cells/µL after 3 years of viral suppression had substantially increased mortality (adjusted hazard ratio, 2.60; 95% confidence interval, 1.86-3.61) compared with those who achieved CD4 count >200 cells/µL. The increased mortality was seen across different patient groups and for all causes of death. CONCLUSIONS: Virally suppressed HIV-positive individuals on cART who do not achieve a CD4 count >200 cells/µL have substantially increased long-term mortality.


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Times Cited: 83

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