March 2, 2010

Normal Life Expectancy With Maintenance of CD4s Above 500

Survival among HIV-positive men who keep their CD4 counts above 500 cells for at least three years is comparable with that of the general population, according to optimistic data from a large European cohort reported on Friday, February 19, at the 17th Conference on Retroviruses and Opportunistic Infections (CROI). More sobering findings were documented among HIV-positive women: mortality rates, even among those responding well to antiretroviral (ARV) therapy, were still lower compared with HIV-negative women.

Thought combination ARV therapy is lauded for its life-extending potential for people living with HIV, premature death rates—from any cause (all-cause mortality)—remain higher among HIV-positive people receiving treatment compared with those in the general population.

Both the mortality rate and the excess mortality risk to be lower in those with higher CD4 counts, explained Charlotte Lewden, MD, of the University of Bordeaux in Bordeaux, France and her colleagues explained. Lewden’s group recalled a previous study finding that death rates among HIV-positive individuals were CD4 counts of 500 cells and higher after several years of ARV therapy were similar to those of the general population.

To confirm this suggestion, Lewden’s group set out to evaluate data involving people living with HIV participating in one of 25 cohorts in 30 countries throughout Europe. The collected data, reflecting more than 80,000 individuals, were pooled in the continent-wide COHERE study. Participants were approximately 37 years old when they started ARV therapy for the first time, with an average CD4 count of 225 cells.

Mortality rates, calculated upon reviewing the 3,813 deaths reported over the 3.5-year follow-up period, were determined for patients with difference CD4 counts (below 200 cells, between 200 and 350 cells, between 351 and 500 cells and more than 500 cells). Standard mortality ratios (SMRs)—calculations that allow comparisons between HIV-positive people with different CD4 cell counts and HIV-negative individuals in the general population—were also conducted.

Overall, based on a review of patients’ most recent CD4 cell counts—a single measurement only—the death rate among those living with HIV was 4.4 times higher compared with rates expected in the age-matched general population. Not surprisingly, the rate was highest among those with CD4s below 200 compared with those with CD4s above 500—13 times versus 1.5 times more deaths, respectively.

Among men, there were four times as many deaths among those with CD4s below 200 versus 1.4 times more deaths among those with CD4s above 500. Among women, death rates were 7.8 times higher among those with CD4s below 200 compared with 2.2 times higher among those with CD4s above 500.

Rates improved when the researchers looked at the length of time HIV-positive individuals kept their CD4 counts above a specific threshold, taking into account measurements collected over time.

Among HIV-positive men who maintained CD4 counts above 500 cells for at least three years, death rates were virtually identical to those expected in the general population—an statistically insignificant 1.1-fold (10 percent) increase in the number of deaths.

Among the HIV-positive women, unfortunately, death rates failed to equalize, even after five years of CD4 counts maintained above 500 cells: a 2.4-fold increase in the number of deaths compared with those in the general population. 

“Though our results”—notably the differences between men and women in the study—“might be partly explained by other differences between HIV-infected and uninfected populations, they point to the importance of maintaining high CD4 cell counts as well as long term treatment adherence,” Lewden’s group concluded.

Search: CD4 cells, survival, mortality, men, women, Lewden, COHERE, CROI

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Previous Comments:

Moses Chirimbana, Oshakati, 2010-06-21 10:44:31
Thank you for your enriching information

Edache Anejo, , 2010-05-22 11:11:03
I started ARV january last year when my CD4 Was 80. Since then, it hovers between 120 and 150.Pls what must i do to increase my CD4 count.

antonio, Houston, 2010-05-09 22:08:16
I will make this short and sweet. I have been living with HIV AIDS for over 30 years now. Can any doctor explain this to me. I have been given 5 death sentences. I am still here. AIDS THE BIG LIE. The US Government got what they wanted here and in the Belgium Congo........Tks Dr. Hilary Koprowski the father of AIDS...

jerry, Saint Petersburg FL, 2010-04-28 04:11:44
What about those of us who cant seem to get t cells to stay over 300 most of the time.

Jon, Vancouver, 2010-03-30 16:52:59
The headline for this article brightened my day considerably. When I first read it I thought, "Wow! If I maintain my CD4 counts, I'll live to be at least 500!"

Tools, South africa, 2010-03-22 18:02:18
I don't view HIV-aids as a death sentence anymore after witnessing my brothers mirreculous recovery, for10 years after his 14 month old died he was in denial that he was infected because he never got sick, he survived on good exercise, good nutrition and a positive healthy mind for 10 year, I know of 6 of his friends that have died because they had no support system and they took the disease as death row and never survived it, I strongly believe in a strong positive mind, that plays a huge rol

Tools, South africa, 2010-03-21 22:19:52
My brother's cd4 count was 44 when he got sick, Dr said it was amazing that he was still walking. 2 months after arv therapy. He was back to normal, the only thing that did not return 100 percent is his cognition. His personality has changed from mellowto aggresive and agitated, he is taking his meds religiously, back to work, gain weight and resumed his physical training, 6 months after he started treatment his cd4 count went up to mere 199, amazingly he is well. And healthy.

Sam, , 2010-03-10 13:22:12
TOTAL LIE, unless you can live a normal life without bones, Liver, Kidneys.

Mike, Tampa Florida, 2010-03-04 19:30:53
My partner died 2 yrs ago. Liver cancer, but the last 2 months of life he had KS legions all over his body as he had yrs before. There were several other signs of AIDS as complications in addition. Cause of death on certificate was respiratory failure. He was 41. You can make stats anything you want and it is true when one dies they stop breathing pretty generic, but I guess he won't make the AIDS death stats? The dutch boy has his finger in the leaking dike, nonetheless it leaks still.

Ejikeme P. Nwosu, Lagos, Nigeria., 2010-03-03 15:58:02
I am so optimistic that by the time I am done with my proposed research on HIV/AIDS, I would come out with a cure or better treatment.

First and Last, Maryland, 2010-03-03 15:17:14
This research report is giving out false hope. I have been living with HIV for 26+ years. Haven't had any full blown AIDS symptoms yet.

Survivor4me, , 2010-03-03 15:16:59
Sorry but I don't find this very conclusive or convincing. The study mentions 35 y/o patient; no 60 y/o patients. Being HIV poz and over 50 I am very skeptical of my personal mortality.

Tim, Pittsburgh, 2010-03-03 11:02:23
After reading the study itself, I am afraid there is far less here than meets the eye. ARV increases life expectancy, but not as dramatically as this headline would suggest. They picked low-hanging fruit -- the healthiest people lived the longest, which is hardly reason to stop the presses. The study also hedges quite dramatically when discussing comorbidities over the term of the life course, but does suggest that HIV people might want to open retirement accounts.