Abstract
ObjectiveTo evaluate the impact of AIDS-defining events (ADE) on long-term mortality of HIV positive individuals on antiretroviral therapy (ART), a retrospective HIV/AIDS treatment cohort study performed in Southwestern China.MethodsThe retrospective cohort was conducted among 6757 HIV/AIDS patients on ART (2NRTIs + 1NNRTI, 2NRTIs + 1PI and Single or two drugs) recruited in Guigang city, Guangxi, China, from January 2004 to December 2018. Participants were divided into ADE and non-ADE groups, and were followed-up every six months to observe treatment outcomes. Comparison of mortality between groups was performed using the log-rank test and Kaplan–Meier analysis. Cox proportional hazard regression was used to explore the risk factors of mortality. 1:1 propensity score matching (PSM) was used to balance confounding factors and adjust the mortality risk.ResultsOf 6757 participants with 29,096.06 person-years of follow-up, 16.86% (1139/6757) belonged to ADE group while the others (83.14%) belonged to the non-ADE group. The most common cause of death by ADE was disseminated mycosis (31.65%), followed by recurrent severe bacterial pneumonia (28.48%), herpes zoster (17.72%), and extra-pulmonary tuberculosis (8.86%). The mortality of the ADE group was significantly higher than that of the non-ADE group [3.45/100 person-years (95% CI 2.92–3.97) vs. 2.34/100 person-years (95% CI 2.15–2.52), P<0.001]. The death risk of the ADE group was also higher than that of the non- ADE group [adjusted hazard ratio (aHR) = 1.291, 95% CI 1.061–1.571, P = 0.011], which was confirmed by PSM analysis (aHR = 1.581, 95% CI 1.192–2.099, P = 0.002). Cox analysis indicated that ADE, older age, male gender, previous non-use of cotrimoxazole, advanced WHO clinical stage, and low baseline CD4+ cell count were the risk factors for death.ConclusionsEven on ART, the mortality risk of HIV positive individuals with ADE was higher than those without ADE. Active testing, earlier diagnosis, and timely therapy with ART may reduce the death risk of ADE.
Highlights
Since the first case of the human immunodeficiency virus (HIV) infection was reported in 1981, 36.9 million people have been infected with HIV; the worldwide mortality rate of HIV/AIDS patients was 23.8% in 2017 [1]
Research showed that 45.1% patients were in the advanced stages of AIDS when they were diagnosed [8], which might be the main reason for the high mortality rate in HIV positive individuals, even when they are on antiretroviral therapy (ART)
In this study, we aimed to evaluate the effect of AIDS-defining events (ADE) on the mortality rate of HIV/AIDS patients who were on ART, providing a basic understanding of the relationship between ART and ADE from a perspective different from those of previous studies
Summary
Since the first case of the human immunodeficiency virus (HIV) infection was reported in 1981, 36.9 million people have been infected with HIV; the worldwide mortality rate of HIV/AIDS patients was 23.8% in 2017 [1]. Huang et al AIDS Res Ther (2020) 17:44 in China, with mortality rate of 23.55% [2, 3]. A province in Southwestern China, has the second highest number of reported HIV cases in the country, with 703,000 survivals and 40,500 deaths by 2017. Research showed that 45.1% patients were in the advanced stages of AIDS when they were diagnosed [8], which might be the main reason for the high mortality rate in HIV positive individuals, even when they are on ART
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