Abstract
BackgroundAt the end of 2009, a total of 501 AIDS patients were receiving antiretroviral therapy (ART) in Fujian Province in China, yet there were no assessments to determine treatment efficacy and HIV-1 preventive potency under the current health care delivery system.MethodsDuring the period of 2005–2009, we assessed the outcomes of initial ART by following up 381 patients for 12 months in Fujian Province. CD4+ T-lymphocyte (CD4) count, plasma viral load (VL), and patient characteristics were analysed. The results were compared between 4 groups divided by the baseline CD4 values at the 25, 50 (median), and 75 percentiles.FindingsOver three-quarters of the subjects reported heterosexual contact as the probable route of transmission. After 12 months of ART, CD4 recovery varied between the 4 groups (P < 0.001), but VL sharply declined regardless of the baseline CD4 count (P = 0.136). Although this VL decline indicates the potency of ART as an HIV-1 prevention tool, the time between positive diagnosis and ART initiation suggests serious delay in both diagnosis and treatment; the medians of periods for the lowest and highest baseline CD4 quartiles were 1.2 and 9.6 months, respectively.ConclusionCurrent limitations in VL determination make it difficult to assess the efficacy of initial ART, and delays in diagnosis and treatment suggest that subjects contributed to HIV-1 transmission while they were not receiving ART. The current National Free ART scheme does not provide free treatment for sexually transmitted infection (STI), and there is no link between ART and the STI care delivery system. This may interfere with the HIV-1 preventive potency of ART. We highly recommend establishing a collaborating mechanism with STI care, strengthening the VL determination system, and promoting HIV tests and early ART initiation.
Highlights
At the end of 2011, the number of people living with HIV (PLHIV) in China was 780,000, accounting for 0.058% of the total population
Free antiretroviral therapy (ART) was initiated in Fujian Province in 2005
Patients who met the national treatment guidelines entry criteria were selected to initiate antiretroviral therapy (ART); these include a CD4+ T-lymphocyte (CD4)+T-lymphocyte (CD4) count < 200/μl, a total lymphocyte count < 1200/μl, or HIV stage III clinical condition according to the World Health Organization (WHO) [7]
Summary
At the end of 2011, the number of people living with HIV (PLHIV) in China was 780,000, accounting for 0.058% of the total population. The proportions of PLHIV who contracted HIV-1 through sexual contact and injecting drug use are 75.2% and 17.3%, respectively [1] Under these circumstances, an ongoing project entitled ‘HIV Testing and ART Treatment as Prevention Strategies’ was initiated in China in 2011 in order to assess the preventive effects of ART in sero-discordant couples [2]. Of the HIV-infected people in Fujian, the proportion of persons in whom HIV was transmitted by their HIV-positive spouse or (stable) partner was 17.3% in 2009 [3] In this context, free ART was initiated in Fujian Province in 2005. We conducted this study to assess the initial provision of ART in order to identify problems in the current system that interfere with the HIV-1 preventive potency of ART in Fujian Province. This is the first longitudinal study implemented to accomplish these objectives in Fujian Province
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