Next Article in Journal
Older Adult Employment Status and Well-Being: A Longitudinal Bidirectional Analysis
Next Article in Special Issue
Early Occupational Therapy Intervention in the Hospital Discharge after Stroke
Previous Article in Journal
The Mechanism and Mediating Effect of the “Perception–Emotion–Behaviour” Chain of Tourists at World Natural Heritage Sites—A Case Study from Bayanbulak, China
Previous Article in Special Issue
Impact of a Brief Family Skills Training Programme (“Strong Families”) on Parenting Skills, Child Psychosocial Functioning, and Resilience in Iran: A Multisite Controlled Trial
Article

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

1
Department of Dermatology and Venereology, Medical University of Innsbruck, 6020 Innsbruck, Austria
2
Austrian HIV Cohort Study, 6020 Innsbruck, Austria
3
Division of Immunology, Allergy and Infectious Diseases, Department of Dermatology, Medical University of Vienna, 1090 Vienna, Austria
4
Otto-Wagner Hospital, 1140 Vienna, Austria
5
Department of Dermatology, Med. Campus III, Kepler University Hospital Linz, Johannes Kepler University Linz, 4040 Linz, Austria
6
Department of Internal Medicine, General Hospital Graz South-West, 8020 Graz, Austria
7
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
8
1st Medical Department, General Hospital Klagenfurt, 9020 Klagenfurt, Austria
9
Kaiser-Franz-Josef Hospital Vienna, 1100 Vienna, Austria
10
Department of Internal Medicine, Oncology, Haematology, Infectious Diseases, State Hospital Feldkirch, 6800 Feldkirch, Austria
11
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
12
Department of Social and Preventive Medicine, Medical University of Vienna, 1090 Vienna, Austria
13
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, 8006 Zurich, Switzerland
*
Author to whom correspondence should be addressed.
Collaborators of the Austrian HIV Cohort Study Group are indicated in the Acknowledgment section.
Academic Editor: Paul B. Tchounwou
Int. J. Environ. Res. Public Health 2021, 18(23), 12532; https://doi.org/10.3390/ijerph182312532
Received: 16 September 2021 / Revised: 24 November 2021 / Accepted: 26 November 2021 / Published: 28 November 2021
(This article belongs to the Special Issue Ensure Healthy Lives and Promote Wellbeing for All at All Ages)
(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/mm3. 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/mm3, 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. View Full-Text
Keywords: cohort study; cause-specific mortality; CD4; cART; risk factors cohort study; cause-specific mortality; CD4; cART; risk factors
Show Figures

Figure 1

MDPI and ACS Style

Leierer, G.; Rieger, A.; Schmied, B.; Sarcletti, M.; Öllinger, A.; Wallner, E.; Egle, A.; Kanatschnig, M.; Zoufaly, A.; Atzl, M.; Rappold, M.; El-Khatib, Z.; Ledergerber, B.; Zangerle, R.; on behalf of the Austrian HIV Cohort Study Group. A Lower CD4 Count Predicts Most Causes of Death except Cardiovascular Deaths. The Austrian HIV Cohort Study. Int. J. Environ. Res. Public Health 2021, 18, 12532. https://doi.org/10.3390/ijerph182312532

AMA Style

Leierer G, Rieger A, Schmied B, Sarcletti M, Öllinger A, Wallner E, Egle A, Kanatschnig M, Zoufaly A, Atzl M, Rappold M, El-Khatib Z, Ledergerber B, Zangerle R, on behalf of the Austrian HIV Cohort Study Group. A Lower CD4 Count Predicts Most Causes of Death except Cardiovascular Deaths. The Austrian HIV Cohort Study. International Journal of Environmental Research and Public Health. 2021; 18(23):12532. https://doi.org/10.3390/ijerph182312532

Chicago/Turabian Style

Leierer, Gisela, 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. 2021. "A Lower CD4 Count Predicts Most Causes of Death except Cardiovascular Deaths. The Austrian HIV Cohort Study" International Journal of Environmental Research and Public Health 18, no. 23: 12532. https://doi.org/10.3390/ijerph182312532

Find Other Styles
Note that from the first issue of 2016, MDPI journals use article numbers instead of page numbers. See further details here.

Article Access Map by Country/Region

1
Back to TopTop