Lower Mortality in Persons Infected with HIV Receiving Antiretroviral Treatment in a Hospital-Based Model: An Observational Cohort Study

Abstract

ABSTRACT: Aim: Although the National Free Antiretroviral Treatment Program (NFATP) is effectively administered through a community-based treatment model in China, there are some limitations in this model. No-one has reported the outcomes of highly active antiretroviral therapy as part of a hospital-based HIV treatment model in China. Methods: This study was a retrospective analysis of mortality and viral responses in HIV-positive patients taking highly active antiretroviral therapy regimens in a cohort registered in Ditan Hospital, Beijing, China, the largest infectious disease hospital in North China. Results: This study demonstrated low mortality (3.4% of patients died in a median follow-up of 19 months, with a mortality of 1.7 per 100 person-years) from 2005 to 2010 in Ditan Hospital. In an adjusted Cox proportional hazards regression analysis, CD4 cell counts less than 50 cells/μl (adjusted hazard ratio of 5.95 [95% CI: 1.3–28.2]) was the strongest risk factor for death, and switching regimens during treatment was associated with lower risk of death. The study also demonstrated 93.4% of patients were adequate viral suppression, 3% were definite virologic failure, 2% were probable virologic failure and 1.3% were indeterminate. In logistic regression analysis, the strongest risk factors for inadequate viral suppression or failure were single, divorced or widowed (adjusted odds ratio: 4.2; 95% CI: 1.2–14.9) and baseline alanine aminotransferase >100 U/l (adjusted odds ratio: 6.2; 95% CI: 1.5–26.1). Conclusion: The hospital-based HIV treatment model appeared to be successful in improving patient survival and should be considered as an important alternative to the community-based treatment models commonly applied in China.