Abstract
BackgroundThe availability and accessibility of effective antiretroviral therapy (ART) for people living with HIV (PLWH) has substantially improved in the past two decades in resource-limited settings. Therefore, evaluation of survival is needed in the current setting.MethodWe retrospectively analyzed secondary data of the national AIDS program database from national health security region number 4 among PLWH who were ART-naive between January 2014 and December 2018. All PLWH were followed until December 2019 to evaluate their survival status and possible risk factors related to death.ResultsA total of 42,229 PLWH were identified, of which 14,053 were ART-naive and thus enrolled in the study. Sixty-seven percent were male, the mean ± SD age was 35 ± 12 years, and the median (IQR) baseline CD4 count was 162 (44–353) cells/mm3. Regarding medical care benefits, 46% had a universal health coverage scheme, 34% had a national social security scheme, and 2% had a civil servants medical benefit scheme. A total of 2142 (15%) mortalities occurred during the total follow-up period of 28,254 patient-years. The mortality rate was 7.5 (95% CI 7.2–7.9) per 100 person-years. Survival rates at 1, 2, 3, 4 and 5 years after HIV registration were 88.2% (95% CI 87.6–88.7%), 85.3% (95% CI 84.6–85.9%), 82.9% (95% CI 81.9–83.4%), 81.3% (95% CI 80.5–82.0%) and 75.1% (95% CI 73.5–76.8%), respectively. The Cox proportional hazards model showed that all-cause mortality was associated with a history of ART switching (HR = 7.06, 95% CI 4.53–11.00), major opportunistic infections during ART (HR = 1.93, 95% CI 1.35–2.77), baseline CD4 count ≤ 200 vs. > 500 cells/mm3 (HR = 4.00, 95% CI 1.45–11.11), age ≥ 50 vs. < 30 years (HR = 1.77, 95% CI 1.12–2.78), and receiving nevirapine-based regimens(HR = 1.43, 95% CI 1.04–1.97).ConclusionsThis study demonstrated the substantial mortality rate over the consecutive 5 years of the follow-up period among PLWH who received ART in a resource-limited setting. Early case finding and prompt initiation of ART as well as continuous HIV care are a cornerstone to improve survival.
Highlights
There is an estimated 37.7 million people living with HIV (PLWH) globally [1]
Survival rates at 1, 2, 3, 4 and 5 years after HIV registration were 88.2%, 85.3%, 82.9%, 81.3% and 75.1%, respectively
The Cox proportional hazards model showed that all-cause mortality was associated with a history of antiretroviral therapy (ART) switching (HR = 7.06, 95% confidence interval (CI) 4.53–11.00), major opportunistic infections during ART (HR = 1.93, 95% CI 1.35–2.77), baseline CD4 count ≤ 200 vs. > 500 cells/mm3 (HR = 4.00, 95% CI 1.45–11.11), age ≥ 50 vs. < 30 years (HR = 1.77, 95% CI 1.12–2.78), and receiving nevirapine-based regimens(HR = 1.43, 95% CI 1.04–1.97)
Summary
There is an estimated 37.7 million people living with HIV (PLWH) globally [1]. In Thailand, there is an estimated 500,000 PLWH, and 12,000 people died of AIDS-related illnesses in 2020. Thailand is considered to be one of the countries with a high HIV burden. In 2020, Joint United Nations Programme on HIV/AIDS (UNAIDS)’ 90–90–90 targets in Thailand were 94% of PLWH diagnosed and knew their status, 83% received ART, and of those on treatment, 97% were virologically suppressed [1]. HIV suppression rates among PLWH have increased significantly, up to 77% in 2020, compared to only 53% in 2015 [3]. The availability and accessibility of effective antiretroviral therapy (ART) for people living with HIV (PLWH) has substantially improved in the past two decades in resource-limited settings. Evaluation of survival is needed in the current setting
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