Effect of earlier initiation of antiretroviral treatment and increased treatment coverage on HIV-related mortality in China: a national observational cohort study

• Published in: The Lancet infectious diseases 2011-07, Vol.11 (7), p.516-524
• Main Authors: Zhang, Fujie, Prof, Dr, Dou, Zhihui, MS, Ma, Ye, Prof, Zhang, Yao, MD, Zhao, Yan, MD, Zhao, Decai, MS, Zhou, Shuntai, MD, Bulterys, Marc, MD, Zhu, Hao, MS, Chen, Ray Y, MD
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; Adult; Anti-HIV Agents - administration & dosage; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antiretroviral agents; Antiretroviral Therapy, Highly Active - methods; Antiviral agents; Biological and medical sciences; Blood transfusion; CD4 antigen; CD4 Lymphocyte Count; China - epidemiology; Cohort Studies; Data processing; Disease control; Drug abuse; Epidemiology; Female; highly active antiretroviral therapy; HIV; HIV Infections - drug therapy; HIV Infections - immunology; HIV Infections - mortality; Human immunodeficiency virus; Human viral diseases; Humans; Immunodeficiencies; Immunodeficiencies. Immunoglobulinopathies; Immunopathology; Infectious Disease; Infectious diseases; Male; Medical sciences; Middle Aged; Mortality; Observational studies; Pharmacology. Drug treatments; Prevention; Proportional Hazards Models; Risk Factors; Sexually transmitted diseases; STD; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids
• ISSN: 1473-3099; 1474-4457
• DOI: 10.1016/S1473-3099(11)70097-4

Summary Background Overall HIV mortality rates in China have not been reported. In this analysis we assess overall mortality in treatment-eligible adults with HIV and attempt to identify risk factors for HIV-related mortality. Methods We used data from the national HIV epidemiology and treatment databases to identify individuals aged 15 years or older with HIV who were eligible for highly active antiretroviral therapy between 1985 and 2009. Mortality rates were calculated in terms of person-years, with risk factors determined by Cox proportional hazard regression. Treatment coverage was calculated as the proportion of time that patients who were eligible for treatment received treatment, with risk factors for not receiving treatment identified by use of logistic regression. Findings Of 323 252 people reported as having HIV in China by the end of 2009, 145 484 (45%) were identified as treatment-eligible and included in this analysis. Median CD4 count was 201 cells per μL (IQR 71–315) at HIV diagnosis and 194 cells per μL (73–293) when first declared eligible for treatment. Overall mortality decreased from 39·3 per 100 person-years in 2002 to 14·2 per 100 person-years in 2009, with treatment coverage concomitantly increasing from almost zero to 63·4%. By 2009, mortality was higher and treatment coverage lower in injecting drug users (15·9 deaths per 100 person-years; 42·7% coverage) and those infected sexually (17·5 deaths per 100 person-years; 61·7% coverage), compared with those infected through plasma donation or blood transfusion (6·7 deaths per 100 person-years; 80·2% coverage). The two strongest risk factors for HIV-related mortality were not receiving highly active antiretroviral therapy (adjusted hazard ratio 4·35, 95% CI 4·10–4·62) and having a CD4 count of less than 50 cells per μL when first declared eligible for treatment (7·92, 7·33–8.57). Interpretation An urgent need exists for earlier HIV diagnosis and better access to treatment for injecting drug users and patients infected with HIV sexually, especially before they become severely immunosuppressed. Funding The National Centre for AIDS/STD Control and Prevention of the Chinese Centre for Disease Control and Prevention.