Long-term mortality in HIV patients virally suppressed for more than three years with incomplete CD4 recovery: A cohort study

In a nationwide cohort of HIV patients we identified all individuals who started HAART before 1 January 2005 with CD4 cell count ≤ 200 cells/μL and experienced three years with sustained viral suppression. Patients were categorized according to CD4 cell count after the three years suppressed period (≤ 200 cells/μL; immunological non-responders (INRs), >200 cells/μL; immunological responders (IRs)). We used logistic regression and Kaplan-Meier analysis to estimated risk factors and mortality for INRs compared to IRs.We identified 55 INRs and 236 IRs. In adjusted analysis age > 40 years and > one year from first CD4 cell count ≤ 200 cells/μL to start of the virologically suppressed period were associated with increased risk of INR. INRs had substantially higher mortality compared to IRs. The excess mortality was mainly seen in the INR group with > one year of immunological suppression prior to viral suppression and injection drug users (IDUs).Age and prolonged periods of immune deficiency prior to successful HAART are risk factors for incomplete CD4 cell recovery. INRs have substantially increased long-term mortality mainly associated with prolonged immunological suppression prior to viral suppression and IDU.The introduction of HAART has decreased morbidity and mortality in HIV patients due to viral load (VL) suppression and immunological recovery [1]. Still, the immunological reconstitution after HAART initiation varies depending on the pre-HAART level of immunodeficiency [2-7]. Several studies have shown that patients with successful virological response to HAART and incomplete initial CD4 recovery have increased mortality [5,8,9]. However, the outcome is poorly documented for patients with pesistent low CD4 count despite several years of HAART with sustained VL suppression.Within a nationwide cohort of HIV infected patients we identified all individuals who were on stable HAART, had been virally suppressed for more than three years and had a CD4 cell count ≤ 200 c