Cause-specific mortality among HIV-infected individuals, by CD4R cell count at HAART initiation, compared with HIV-uninfected individuals

Objectives: To compare the proportion, timing and hazards of non-AIDS death and AIDS death among men and women who initiated HAART at different CD4 ₊ cell counts to mortality risks of HIV-uninfected persons with similar risk factors. Design: Prospective cohort studies. Methods: We used parametric mixture models to compare proportions of AIDS and non-AIDS mortality and ages at death, and multivariable Cox models to compare cause-specific hazards of mortality, across levels of CD4₊ cell count at HAART initiation (≤200 cells/μl: 'late', 201-350 cells/μl: 'intermediate', 350 cells/μl: 'early') and with HIV-uninfected individuals from the Multicenter AIDS Cohort Study and the Women's Interagency HIV Study. We used multiple imputation methods to address lead-time bias in sensitivity analysis. Results: Earlier initiators were more likely to die of non-AIDS causes (early: 78%, intermediate: 74%, late: 49%), and at older ages (median years 72, 69, 66), relative to later initiators. Estimated median ages at non-AIDS death for each CD4₊ cell count category were lower than that estimated for the HIV-uninfected group (75 years). In multivariable analysis, non-AIDS death hazard ratios relative to early initiators were 2.15 for late initiators (P 0.01) and 1.66 for intermediate initiators (P=0.01); AIDS death hazard ratios were 3.26 for late initiators (P 0.01) and 1.20 for intermediate initiators (P=0.28). Strikingly, the adjusted hazards for non-AIDS death among HIV-uninfected individuals and early initiators were nearly identical (hazard ratio 1.01). Inferences were unchanged after adjustment for lead-time bias. Conclusion: Results suggest the possibility of reducing the risk of non-AIDS mortality among HIV-infected individuals to approximate that faced by comparable HIV-uninfected individuals.