Abstract
BackgroundsThere are few studies focus on the factors underlying the late initiation of ART in China. We analyzed the trends in the median CD4 cell counts among different patient groups over time and the risk factors for the late initiation of ART in Shanghai, China.MethodsA retrospective cross-sectional survey was made in the Department of Infectious Disease of Shanghai Public Health Clinical Center which is a designated diagnosis and treatment center for HIV-positive patients in Shanghai during the period of January 1st, 2008--June 30th, 2014. Late ART initiation was defined as a CD4 cell count <200 cells/mm3 or having a clinical AIDS diagnosis prior to ART initiation. Trends in the median CD4 cell count at ART initiation and the proportion of late ART initiation by year were evaluated using Spearman’s correlations and Chi-squared methods, respectively. We used a logistic regression model to analyze the risk factors for late ART initiation. The related factors collected in the multivariate model were the patient’s age, gender, infection routes and marital status.ResultsA total of 3796 patients were analyzed in this study, with a median baseline CD4 cell count of 205 cells/mm3 [interquartile range: 75–287]. The median CD4 cell counts of patients initiating ART late increased from 76 cells/mm3 in 2008 to 103 cells/mm3 in 2014 (p < 0.001), and the proportion of late ART initiation decreased from 80% to 45% (p < 0.001). The risk factors for late ART initiation were male gender, heterosexual transmission and older age (>30 years) (p < 0.001).ConclusionsNotable improvements were made in the median CD4 cell count at ART initiation and the proportion of late ART initiation from 2008 to 2014. However, persons with high risk of HIV exposure who are male, older even heterosexual orientation should be given more opportunities to receive frequently screening, earlier diagnoses and timely treatment.
Highlights
The morbidity and mortality of Human immunodeficiency virus (HIV) infection have been sharply decreasing all over the world due to the global implementation of antiretroviral therapy (ART), and HIV infection is recognized as a chronic disease instead of a deadly one
As we all know that, targeting the HIV-positive population who are most likely to be at risk for being diagnosed or receiving ART late would facilitate the control of the HIV epidemic
Identifying the factors underlying the current delay of HIV treatment and the risk factors for the late initiation of ART will be helpful to policymakers
Summary
The morbidity and mortality of HIV infection have been sharply decreasing all over the world due to the global implementation of antiretroviral therapy (ART), and HIV infection is recognized as a chronic disease instead of a deadly one. Despite the nationwide scale-up of HIV programs in China over the past decade, the proportion of ART-eligible HIV-positive patients who receive treatment remains low [3, 4]. What even worse is that many HIV-positive people receive late HIV diagnoses [5–7]. Both of these factors weaken the effect of ART among HIV-positive populations [8, 9]. The time to initiation in Shanghai was rapid, and patients with more advanced HIV diagnoses received much quicker referral to our clinic. As we all know that, targeting the HIV-positive population who are most likely to be at risk for being diagnosed or receiving ART late would facilitate the control of the HIV epidemic. Identifying the factors underlying the current delay of HIV treatment and the risk factors for the late initiation of ART will be helpful to policymakers
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