Mortality rate and influencing factors among index partners of HIV discordant couples in the context of antiretroviral therapy, Zhumadian, Henan province, 2008-2014

Abstract

To analyze the mortality rate in index partners of HIV discordant couples in the context of antiretroviral therapy and related factors in Zhumadian, Henan province. An open and prospective cohort survey was conducted annually during 2008-2014. Information about the index partners ' demographic characteristics, CD4(+) T(CD4)cell counts, viral load, AIDS-related syndromes, date of therapy initiation, level of treatment institution, and outcome of death were collected. Life table was used to calculate survival rate, and Cox proportional hazards model was used to analyze the mortality related factors. Among 4 196 index partners receiving antiretroviral therapy between 2008 and 2014, 350 were fatal, with the mortality rate of 1.88 per 100 person years(95%CI: 1.86-1.90). The survival rates of these patients with the duration of follow-up from 1 to 7 years were 99.64%, 97.70%, 95.62%, 93.54%, 91.25%, 86.86% and 82.36% respectively. Factors related to the survival of the index partners of HIV discordant couples were age ≥ 50 years(HR=3.48, 95% CI: 2.67-4.55), junior high school or above education level(HR=0.75, 95% CI: 0.56-1.00), baseline CD4 cell counts >350 cells per μl(HR=0.55, 95% CI: 0.42-0.72), baseline viral load >400 copies/ml(HR=1.71, 95% CI: 1.32-2.22)and initiating treatment prior to cohort entry(HR=0.65, 95% CI: 0.41-1.05). The mortality rate of index partners receiving antiretroviral therapy was relatively low, indicating a better effect of long-term treatment on patients' survival. It is necessary to further identify and control the key factors influencing the survival of patients receiving therapy, improve the timeliness and adherence of the treatment, keeping patients' immunity level. Meanwhile, much attention should be paid to the drug resistance due to long term treatment and treatment failure.