Abstract
In order to assess the effectiveness of the Chinese government’s expanded access program, a cohort study on all adult HIV patients in Shenzhen was conducted from December 2003 to February 2014 to estimate the effects of antiretroviral therapy (ART) on mortality, tuberculosis and CD4 cell counts. Marginal structural regression models adjusted for baseline and time-varying covariates. Of the 6897 patients enrolled and followed up for a maximum of 178 months, 44.92% received ART. Among patients who commenced receiving ART during the study, there were 98 deaths and 59 new tuberculosis diagnoses, while there were 410 deaths and 201 new tuberculosis diagnoses among those without ART. ART was associated with both lower mortality (hazard ratio [HR] = 0.18; 95% confidence interval [CI] = 0.11–0.27) and the presence of tuberculosis (HR = 0.27; 95% CI = 0.19–0.37). Each month of ART was associated with an average increase in CD4 cell count of 6.52 cells/µL (95% CI = 6.08–7.12 cells/µL). In conclusions, the effectiveness of ART provided by China government health services is the same as that in higher-income countries. Accounting to higher mortality rates from the delay of starting ART, faster expansion and timely imitation of ART are urgent.
Highlights
In China, a cumulative 436,817 people living with HIV/Acquired Immune Deficiency Syndrome (AIDS) had been identified as of December 2013, including 173,825 people with AIDS [1,2].A remarkable acceleration in treatment has occurred since the China National Free AntiretroviralTreatment Program (NFATP) was established in 2003 [3,4]
(55.31%) had initial CD4 cell counts less than 350 cells/μL, and 2674 of these (70.09%) initiated antiretroviral therapy (ART)
Among patients with initial CD4 cell counts less than 350 cells/μL, those who were older, female, native, baseline tuberculosis positive, baseline AIDS stage and had a lower initial CD4 cell count were more likely to receive ART
Summary
In China, a cumulative 436,817 people living with HIV/Acquired Immune Deficiency Syndrome (AIDS) had been identified as of December 2013, including 173,825 people with AIDS [1,2].A remarkable acceleration in treatment has occurred since the China National Free AntiretroviralTreatment Program (NFATP) was established in 2003 [3,4]. A remarkable acceleration in treatment has occurred since the China National Free Antiretroviral. By December 2013, antiretroviral therapy (ART) had been given to more than 278,000 people. Health outcomes tend to deteriorate, and a complete picture of ART’s effectiveness may not be available by describing changes in outcomes only among patients with ART. Since treatments are largely selected according to patients’ health status, comparisons of treated and untreated patients are likely to be biased [5,9]. Successive observations of changes in individuals have recently been performed in cohort studies from Europe and South Africa, and it is possible to adjust for these selection biases [11,12]
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