March 13, 2013
Under optimal conditions, HIV-infected people on effective antiretroviral therapy (ART) who have undetectable viral loads and "near-normal" levels of immune cells have a risk of death that is similar to uninfected people, according to Dr. Alison Rodgers of University College London.
These results are based on a three-year study of 3,300 "optimally treated" HIV-infected patients from two large treatment studies, the ESPRIT and SMART trials. Study participants were non-injection drug users whose ART had resulted in undetectable HIV levels and relatively high CD4+ counts (at least 350 cells/mm3). The average age of study participants was 43, and 80 percent were male. During the study, 62 HIV patients died, mostly from cardiovascular disease or "sudden" death (31 percent) and cancers unrelated to HIV (19 percent). Only two died from AIDS-related causes.
The risk of death was 77 percent higher than the general population for patients whose CD4+ cell count was lower than normal (350 to 499 cells/mm3). The risk of death for HIV patients with CD4+ cell count of 500 cells/mm3 or higher was about the same as the general population's risk of death.
Rodgers and his colleagues urged people to be tested for HIV since early diagnosis and optimal treatment can prevent mortality associated with HIV. The researchers also recommended additional research to identify the level of CD4+ cell counts that warrant ART.
The full report, "Mortality in Well Controlled HIV in the Continuous Antiretroviral Therapy Arms of the SMART and ESPRIT Trials Compared to the General Population," was published online in the journal AIDS (2013; doi: 10.1097/QAD.0b013e32835cae9c).