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Objective:

To determine the relationship between mortality risk and the CD4 cell response to antiretroviral therapy (ART).

Design:

Observational community-based ART cohort in South Africa.

Methods:

CD4 cell counts were measured 4 monthly, and deaths were prospectively ascertained. Cumulative person-time accrued within a range of updated CD4 cell count strata (CD4 cell-strata) was calculated and used to derive CD4 cell-stratified mortality rates.

Results:

Patients (2423)(median baseline CD4 cell count of 105 cells/μl) were observed for up to 5 years of ART. One hundred and ninety-seven patients died during 3155 person-years of observation. In multivariate analysis, mortality rate ratios associated with 0–49, 50–99, 100–199, 200–299, 300–399, 400–499 and at least 500 cells/μl updated CD4 cell-strata were 11.6, 4.9, 2.6, 1.7, 1.5, 1.4 and 1.0, respectively. Analysis of CD4 cell count recovery permitted …