For the first time, a cohort study of people with HIV has found that a fairly substantial proportion of patients – namely those who maintain a CD4 cell count of over 500 cells/mm3 – have a death rate that is not significantly greater than the in general HIV-negative population.
The study analysed the mortality rate of 2279 patients in the Aquitaine Cohort, which comprises patients prospectively enrolled since 1987 in a hospital-based surveillance system of HIV infection in southwestern France. The selected patients had all started protease inhibitor -based antiretroviral therapy between 1997 and 1999 and their mortality rates were followed up until June 2003.
Of these patients, 549 (24%) were defined as Favourable Responders. This meant they had, to quote the study, “at least two CD4 counts over 500, no count under 500 and no viral load over 10,000 in the year preceding the last available data.”
Of these favourable responders, seven (0.7%) died. When compared to people in the general population of the same gender and similar age, this mortality rate was only 10% above normal – a non-significant difference. This yielded a ‘standardised mortality ratio’ (SMR) of 1.1.
Patients maintaining CD4 cell counts over 350 but under 500 cells/mm3 in the year before the last data had an annual death rate of 0.9%, yielding a SMR of 3.1, meaning that they were just over three times as likely to die as the general public; those with CD4 cell counts over 200 but under 350 cells/mm3 had a SMR of 4.8; and those with CD4 cell counts under 200 cells/mm3 had an SMR of 23.6.
The overall death rate in the group was 2.2% or 8 times what one would expect in the general population. Only half of the deaths were due to AIDS-related conditions.
The study also collected mortality data on other patient subsets. These, alongside the figures above, are best summarised in table form:
| Subgroup | Proportion of patients (%) | Annual Mortality (%) | Standardised Mortality Ratio |
| Men | 76.5 | 2.2 | 5.4 |
| Women | 23.5 | 2.1 | 14.1 |
| Injecting drug users | 19.4 | 3.2 | 18.6 |
| Non-drug users | 80.6 | 1.9 | 6.4 |
| With hepatitis C | 24.3 | 3.1 | 13.6 |
| Without hepatitis C | 75.7 | 1.9 | 6.3 |
| CD4s ≥ 500 for a year | 24.1 | 0.3 | 1.1 |
| CD4s 350-499 | 25.5 | 0.9 | 3.1 |
| CD4s 200-349 | 21.9 | 1.8 | 4.8 |
| CD4s under 200 at least once during year | 28.5 | 6.8 | 23.6 |
| ALL PATIENTS | 100 | 2.2 | 7.8 |
| Death not due to AIDS | N/A | 1.1 | 3.8 |
The researchers merely conclude by pointing out that favourable treatment responders had the same mortality rates as the general population. However this study should add further to the evidence that people living with HIV who are on successful antiretroviral therapy or have good CD4 cell counts should not be treated as ineligible for life-insurance.
Lewden C. Responders to antiretroviral treatment over 500 CD4/mm3 reach same mortality rates as general population: APROCO and Aquitaine Cohorts, 10th European AIDS Conference, France, abstract PE18.4/8, 2005.