Abstract
ObjectivesThe objective of this study was to determine the rate of acquired immune deficiency syndrome (AIDS) in Zhejiang province and to identify specific factors associated with progression of this disease.MethodsThis study utilized a retrospective cohort to identify the specific factors involved in the progression of human immunodeficiency virus (HIV) to AIDS. We collected data of patients existing in care between 2008 and 2012 from the national surveillance system databases. We performed our analyses using a multivariate Cox proportional hazards model.ResultsThis study included 9216 HIV-positive patients (75.6 % male), which yielded 12,452 person-years (py) of follow-up-data. The AIDS progression rates were 33.9 % (2008), 33.6 % (2009), 38.1 % (2010), 30.6 % (2011) and 25.9 % (2012). We observed a significant reduction in the rate of progression Of HIV to AIDS post-2010 (Pearson χ2 = 4341.9, P < 0.001). The cumulative AIDS progression incidence rates were 33.4, 35.4, 36.4, 37.0 and 37.04 per 100 py in 1 each of the 5 years of follow-up. This study found that age was an independent risk factor for the progression of HIV to AIDS. Compared with patients infected with HIV by homosexual transmission, patients infected with HIV by heterosexuals transmission or blood transfusion had a reduced hazard ratio (HR) for progression to AIDS (heterosexual transmission: HR = 0.695, 0.524, P = 0.007; blood transfusion: HR = 0.524, P = 0.015). Diagnosed with HIV from 2011 to 2012 and having a higher CD4+ cell count (350–500 cells/mm3; or >500 cells/mm3) at baseline were independently associated with lower rates of HIV progression to AIDS [HR = 0.382, 0.380, 0.187, P < 0.001]. Patients with a CD+ T-cell count of 200–350 cells/mm3 or greater than 350 cells/mm3 were less likely to develop AIDS following HIV diagnosis than were those patients without HAART treatment.ConclusionThis study found a high progression rate from HIV to AIDS in HIV patients residing within Zhejiang province from 2008 to 2010. This rate decreased after 2010, which coincided with the new criteria for HAART treatment, which likely contributed to the observed reduction in the rate of progression. Initiation of HAART with higher CD4+ T-cell count may reduce rate of AIDS progression. Based on our results, we conclude that efficient strategies for HIV screening, as well as early diagnosis and treatment are necessary to reduce the progression of HIV to AIDS.
Highlights
Human immunodeficiency virus (HIV), the causative agent of acquired immune deficiency syndrome (AIDS), Chen et al AIDS Res Ther (2015) 12:32(PRC) launched the Four Frees and One Care’ (FFOC) policy in 2003 to reduce the transmission of HIV
By December 31, 2012, 3868 patients progressed from HIV to AIDS in Group one
No significant differences between the demographic characteristics of patients who stopped being monitored during the time of our study compared with those patients whose information was available throughout the study time frame (Table 2)
Summary
Human immunodeficiency virus (HIV), the causative agent of acquired immune deficiency syndrome (AIDS), Chen et al AIDS Res Ther (2015) 12:32(PRC) launched the Four Frees and One Care’ (FFOC) policy in 2003 to reduce the transmission of HIV. In 2010, the criteria for highly active antiretroviral therapy (HAART) was broadened from standards that included patients with a CD4+ T-cell count ≤200 cells/mm to those that included patients with a CD4+ T-cell count ≤350 cells/mm. In 2010, the criteria for highly active antiretroviral therapy (HAART) was broadened from standards that included patients with a CD4+ T-cell count ≤200 cells/mm to those that included patients with a CD4+ T-cell count ≤350 cells/mm3 This modification allowed a greater number of people living with HIV (PLHIV) receive free treatment at an earlier stage of the infection. In 2012, there were a total of 8144 HIV/AIDS patients in Zhejiang. Zhejiang has a higher rate of HIV/AIDS patients than other Chinese provinces with similar populations and economic levels [6, 7]. 57.0 % of the total patients in Zhejiang have been treated with HAART
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