Abstract
BackgroundLimited data are available on clinical outcomes of people living with HIV (PLWH) in China, especially after the implementation of the 2016 national treatment guideline. The objective of the current study is to examine the treatment patterns, clinical outcomes and their associated factors among PLWH in Guangxi, China before and after this new guideline.MethodsData from three community-based projects conducted at different time points over a period of six years (2012–2017) in Guangxi were analyzed in our study. The interviewer-administered questionnaire was used for data collection. Measures of clinical outcomes were retrieved from the patients’ medical records. Descriptive analysis was employed to display treatment patterns and the time trends of clinical outcomes. Chi-square test or ANOVA was used to compare the differences in background characteristics and treatment history between different levels of clinical outcomes.ResultsAmong the pooled sample of 4224 participants, 77.3% were receiving antiretroviral therapy (ART), the median CD4 count was 328 cells/mm3, and 82.5% were virally suppressed. An increasing trend in both ART coverage (from 72.1% to 91.2%) and CD4 count (from 318 cells/mm3 to 357 cells/mm3) was observed over time in the three samples, while rates of viral suppression did not show a similar trend. A number of socio-demographic characteristics (e.g., female gender, younger age, Han ethnicity, and employment) and treatment-related variables (e.g., longer durations of HIV diagnosis and ART uptake, lower prevalence of comorbidity, fewer treatment interruptions, and more knowledge on ART) were associated with improved clinical outcomes.ConclusionsWe observed a high rate of viral suppression and increasing trends in ART coverage and CD4 count over six years in Guangxi, China. However, suboptimal clinical outcomes continue to be a problem, particularly among some subgroups of PLWH. Future clinical management strategies should be tailored for PLWH with different sociodemographic characteristics and treatment trajectories.
Highlights
Antiretroviral therapy (ART) has been used worldwide and achieved great success in HIV treatment and prevention since its advent in the 1990s
We observed a high rate of viral suppression and increasing trends in ART coverage and CD4 count over six years in Guangxi, China
Future clinical management strategies should be tailored for people living with HIV (PLWH) with different sociodemographic characteristics and treatment trajectories
Summary
Antiretroviral therapy (ART) has been used worldwide and achieved great success in HIV treatment and prevention since its advent in the 1990s. The preventive benefits of the early use of ART in asymptomatic HIV infection have been proved with clinical evidence in the last decade [1, 2]. The Joint United Nations Programme on HIV/AIDS (UNAIDS) launched its ambitious 90-90-90 targets in 2014: 90% of the PLWH knowing their HIV status, 90% of the diagnosed PLWH receiving ART, and 90% of the PLWH on ART achieving viral suppression [8]. Across the globe, among the estimated 36.9 million PLWH, only 59% of them were receiving ART and 47% achieved viral suppression among those on ART in 2017 [9]. Limited data are available on clinical outcomes of people living with HIV (PLWH) in China, especially after the implementation of the 2016 national treatment guideline.
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