Abstract
ABSTRACT Background The conventional survival analysis model on HIV/AIDS prognosis is the Cox proportional hazard model, which deals with only one event type, death, regardless of the cause. Few studies have used a competing risk model to evaluate the predictors of AIDS-related mortality. Objective To estimate the influence of antiretroviral therapy (ART) initiation time and baseline CD4+ cell counts on acquired immunodeficiency syndrome (AIDS)-related death among former plasma donors. Methods A retrospective cohort study was conducted involving 11,905 human immunodeficiency virus (HIV) or AIDS patients in a high-risk area of Henan province in China between 1995 and 2016. Demographic and clinical data were collected. Sub-distribution hazard ratios (sHRs) for AIDS-related mortality with baseline CD4+ cell counts and ART initiation time were determined using a competing risk model. Results Patients who initiated ART within 90 days of HIV/AIDS diagnosis (sHR: 0.24, 95% CI: 0.22–0.27) or had baseline CD4+ counts of >500 cells/μL (sHR: 0.23, 95% CI: 0.19–0.28) were associated with lower AIDS-related mortality risk. Patients with ART initiation time >1 year but CD4+ counts >350 cells/μL (sHR: 4.42, 95% CI: 3.30–5.91) had a higher AIDS-related mortality risk than those with ART initiation time >90 days but CD4+ counts ≤350 cells/μL (sHR: 4.33, 95% CI: 3.58–5.23). Conclusions Our results demonstrate that patients with high CD4+ cell counts and late ART had a 9% higher risk of AIDS-related death than those with low CD4+ cell counts and early ART. This study confirms the great significance of immediate ART initiation among former plasma donor HIV patients in China.
Highlights
Human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS) continues to be a major global public health issue
The primary aim of the present study was to explore the effect of antiretroviral therapy (ART) initiation time, CD4+ cell counts and other prognostic factors on AIDS-related death among a cohort of former plasma donors patients (FPD) by competing risk model
3,198 (26.86%) of 11,905 HIV/AIDS patients died of AIDS-related diseases, 607 (5.10%) died owing to non-AIDS-related causes, and 8,100 (68.04%) were still alive or lost to follow-up. 60.65% had already progressed to AIDS on diagnosis (Table 1)
Summary
Human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS) continues to be a major global public health issue. According to the Chinese Center for Disease Control and Prevention statistics, there are an estimated 820,756 individuals living with HIV/AIDS in China and approximately 253,031 individuals have died from AIDS-related causes as 2018. The reuse of syringes and the subsequent reinfusion of mixed red blood cells, led to most of Former Plasma Donors were infected HIV through blood transmission in China, in Henan province. Previous studies found that immediate antiretroviral therapy (ART) when CD4+ counts > 500 cells/μL could reduce mortality[3]. To estimate the influence of antiretroviral therapy (ART) initiation time, baseline CD4+ cell counts and other prognostic factors on AIDS-related death among former plasma donors patients (FPD)
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