Immunologic treatment failure among HIV-infected adult patients in Jiangsu province, China

Tao Qiu,Chongyi Wei,Xiaoyan Liu,Jeff Mandel,Hongjing Yan,Xiping Huan,Gengfeng Fu,Zhi Zhang,Xiaoqin Xu,Haitao Yang,Willi Mcfarland,Ping Ding

doi:10.1038/srep42381

Abstract

The National Free Antiretroviral Treatment Program was implemented in Jiangsu Province, China in 2005. We conducted a retrospective, open cohort study to determine treatment failure rates and associated risk factors. Data were obtained from the national web-based antiretroviral treatment database. WHO criteria were used to define immunologic treatment failure. Kaplan-Meier methods were used to determine treatment failure rates and Cox proportional hazards modeling was used to identify risk factors. A total of 5,083 (87.8%) having at least one CD4 cell count measure were included from 2005 to 2013. Overall, 30.4% had immunologic treatment failure with cumulative treatment failure rates increasing to 50.5% at month 60 and 64.1% at month 90. Factors predicting treatment failure included being treated in the Centers for Disease Control and Prevention system (HR 1.69, 95% CI 1.14–2.50, p = 0.009) or jail hospital (HR 1.20, 95% CI 1.08–1.34, p = 0.001), and having a baseline CD4 count >350 cells/uL (HR 2.37, 95% CI 1.94–2.89. p < 0.001). Immunologic treatment failure was moderate to substantial among treated HIV patients. Providing second-line regimens and shifting treatment providers to professional hospitals should be considered to consolidate gains in averting morbidity and mortality.

Highlights

The National Free Antiretroviral Treatment Program was implemented in Jiangsu Province, China in 2005
Factors predicting treatment failure included being treated in the Centers for Disease Control and Prevention system (HR 1.69, 95% CI 1.14–2.50, p = 0.009) or jail hospital (HR 1.20, 95% CI 1.08–1.34, p = 0.001), and having a baseline CD4 count >350 cells/uL (HR 2.37, 95% CI 1.94–2.89. p < 0.001)
A total of 5,788 records of treatment eligible HIV-positive individuals who initiated Antiretroviral therapy (ART) in Jiangsu province were collected from the web-based database between January 1, 2005 and December 31, 2013

Summary

Introduction

The National Free Antiretroviral Treatment Program was implemented in Jiangsu Province, China in 2005. Factors predicting treatment failure included being treated in the Centers for Disease Control and Prevention system (HR 1.69, 95% CI 1.14–2.50, p = 0.009) or jail hospital (HR 1.20, 95% CI 1.08–1.34, p = 0.001), and having a baseline CD4 count >350 cells/uL In order to reduce HIV-related mortality and new infections, the China National Free Antiretroviral Treatment Program (NFATP) was piloted among former plasma donors in 2002, a population severely affected early in the epidemic, and scaled up to include other HIV-infected groups[2,3]. After a decade of ART scale up began in earnest, some studies have reported treatment failure and drug resistance among HIV-treated adults in China[13,14]. Implementation and management of the treatment programs, including provision of free first-line ART, are responsibilities of local Centers for Disease Control and Prevention (CDC) and government designated hospitals. Recent studies found that HIV-positive patients infected www.nature.com/scientificreports/

Methods

Results

Conclusion