Abstract
BackgroundViral load (VL) is a strong predictor of human immunodeficiency virus (HIV) disease progression. The aim of this study was to evaluate the effect of high baseline VL on antiretroviral therapy (ART) outcomes among HIV-infected patients.MethodsThis retrospective study observed HIV-infected patients who had baseline VL test at ART initiation between 2015 and 2019 in Chongqing, China. Cox proportional hazards regression and logistic regression models were used to evaluate the effects of baseline VL on Acquired immunodeficiency syndrome (AIDS)-related mortality and virologic failure, respectively.ResultsThe cohort included 7,176 HIV-infected patients, of whom 38.7% had a baseline VL ≥ 100,000 copies/mL. Of the patients who died during follow-up, 58.9% had a baseline VL ≥ 100,000 copies/mL. Compared with a baseline VL < 10,000 copies/mL, ART initiation at VL ≥ 100,000 copies/mL was significantly associated with the AIDS-related death (adjusted hazard ratio, AHR = 1.4) and virologic failure (adjusted odds ratio, AOR = 2.4). Compared with patients with a baseline VL < 10,000 copies/mL, patients on the recommended first-line regimen with a VL ≥ 100,000 copies/mL at ART initiaition had higher mortality rate (5.1 vs. 1.7 per 100 person-years), but there was no significant difference in the mortality accoding to the initial VL level among patients on second-line ART (2.8 vs. 2.7 per 100 person-years). ART initiation ≤ 30 days after HIV diagnosis was associated with a lower risk of AIDS-related death (AHR = 0.6).ConclusionsART initiation with VL ≥ 100,000 copies/mL was associated with a significantly greater risk of mortality and virologic failure. Optimizing the ART regimen and initiating ART early may help to reduce mortality effectively among patients with a high baseline VL. VL testing for all HIV patients is recommended at HIV diagnosis or on ART initiation.
Highlights
Antiretroviral therapy (ART) is the most effective intervention to prevent new human immunodeficiency virus (HIV) infections and reduce the risk of Acquired immunodeficiency syndrome (AIDS)-associated mortality [1, 2]
The results showed that the baseline characteristics of HIV patients with and without a baseline Viral load (VL) result were slightly different
Our study showed that high baseline VL was one of the factors associated with antiretroviral therapy (ART) mortality
Summary
Antiretroviral therapy (ART) is the most effective intervention to prevent new human immunodeficiency virus (HIV) infections and reduce the risk of Acquired immunodeficiency syndrome (AIDS)-associated mortality [1, 2]. The World Health Organization recommends early initiation of ART for all newly diagnosed persons with HIV infection, regardless of the CD4 count. In China, the National Free Antiretroviral Treatment Program (NFATP) was initiated in 2003, and in line with the national AIDS control policy of “Four Frees and One Care”, has scaled-up provision of ART. Despite the rapid roll out of ART in China, HIV remains the leading cause of death among infectious diseases, and AIDS-associated mortality continues to be a public health concern of national importance [5, 6]. The aim of this study was to evaluate the effect of high baseline VL on antiretroviral therapy (ART) outcomes among HIV-infected patients
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