Rapid Clinical Progression Among Acute HIV-Infected Men Who Have Sex with Men in China: Findings from a 5-Year Multicenter Prospective Cohort Study

Abstract

Background: In an era of anti-retroviral therapy (ART) and proven risk-reduction strategies, more detailed information is needed on rapid HIV clinical progression among men who have sex with men (MSM) in Asia. We monitored clinical progression in Chinese MSM with acute HIV infection (AHI). Methods: During 2009-2014, we identified 400 AHI cases via periodic testing of 4932 MSM in China. Men with two consecutive CD4 T-cell counts <350 cells/μL within 3-24 months post-infection were considered rapid progressors (RPs). We used Cox models adjusted for sociodemographics to identify factors associated with rapid progression. Findings: Among 400 AHI cases, 46·5% were RPs; 35·1% reached RP status by 12 months post-infection and 63·9% by 24 months. Rapid progression was associated with herpes simplex-2 co-infection (adjusted hazard ratio 1·7, 95% confidence interval 1·2-2·3), depression (1·9, 1·5-2·6), baseline CD4 T-cell count <500/μL (3·5, 2·4-5·1), higher baseline HIV viral load (VL; 1·6, 1·2-2·3), acute symptoms lasting ≥2 weeks (1·6, 1·1-2·2), higher body mass index (0·9, 0·9-1·0), higher HIV VL (1·7, 1·4-2·1) and set point VL (2·0, 1·6-2·5) at 3 months, each 100 cells/μL decrease in CD4 T-cell count at 3 months (2·2, 1·9-2·5), and baseline routine blood tests (medians of white blood cell count, hemoglobin, mean corpuscular hemoglobin and hemoglobin concentration, platelet count and mean volume, lymphocytes, and mixed cell count; all P<0·05). Interpretation Patients diagnosed with AHI, particularly those with RP indicators, should receive immediate ART. AHI screening and regular CD4 T-cell/HIV-VL monitoring among high-risk groups in routine clinical practice are needed. Funding: None. Declaration of interests: All other authors declare no competing interests. Ethics Approval Statement: The Ethics Committee of The First Affiliated Hospital of China Medical University reviewed and approved the study protocol ([2008]73). Written informed consent was obtained from each participant before study enrollment.