Causes of Death among AIDS Patients after Introduction of Free Combination Antiretroviral Therapy (cART) in Three Chinese Provinces, 2010–2011

Although AIDS-related deaths have had significant economic and social impact following an increased disease burden internationally, few studies have evaluated the cause of AIDS-related deaths among patients with AIDS on combination anti-retroviral therapy (cART) in China. This study examines the causes of death among AIDS-patients in China and uses a methodology to increase data accuracy compared to the previous studies on AIDS-related mortality in China, that have taken the reported cause of death in the National HIV Registry at face-value.

Death certificates/medical records were examined and a cross-sectional survey was conducted in three provinces to verify the causes of death among AIDS patients who died between January 1, 2010 and June 30, 2011. Chi-square analysis was conducted to examine the categorical variables by causes of death and by ART status. Univariate and multivariate logistic regression were used to evaluate factors associated with AIDS-related death versus non-AIDS related death.

This study used a sample of 1,109 subjects. The average age at death was 44.5 years. AIDS-related deaths were significantly higher than non-AIDS and injury-related deaths. In the sample, 41.9% (465/1109) were deceased within a year of HIV diagnosis and 52.7% (584/1109) of the deceased AIDS patients were not on cART. For AIDS-related deaths (n = 798), statistically significant factors included CD4 count <200 cells/mm³ at the time of cART initiation, ART naïve and age <39 years.

For the AIDS patients that were deceased, only those who initiated cART while at a CD4 count ≥200 cells/mm3 were less likely to die from AIDS-related causes compared to those who didn’t initiate ART at all.

Below:  Time from diagnosis to death (months), among 1109 deceased patients (across different causes of death)

Below:  Time from diagnosis to death (months), across different cART groups, by cause of death (AIDS, non-AIDS, all causes). (A) Time from diagnosis to death (months), among 798 AIDS-related deaths; (B) Time from diagnosis to death (months), among 216 non-AIDS related deaths; (C) Time from diagnosis to death (months), among 1109 deceased patients; cART group was divided into ART naïve, ART initiation CD4 <200 cells/mm3 and ART initiation CD4 ≥200 cells/mm3.

Full article at: http://goo.gl/neB3Wj

By:

Liyan Wang, Lin Ge, Lu Wang, Wei Guo, Qianqian Qin, Zhengwei Ding, Yan Cui

Division of Epidemiology, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China

Jamie P. Morano

University of South Florida, Morsani College of Medicine, Division of Infectious Disease and International Medicine, USF Medicine International, Tampa, Florida, United States of America

Kaveh Khoshnood

Yale School of Public Health, New Haven, Connecticut, United States of America

Dingyong Sun

Henan Center for AIDS/STD Control and Prevention, Henan Center for Disease Control and Prevention, Henan, China

Xiaoyan Liu

Jiangsu Center for AIDS/STD Control and Prevention, Jiangsu Center for Disease Control and Prevention, Jiangsu, China

Hongbing Luo

Yunnan Center for AIDS/STD Control and Prevention, Yunnan Center for Disease Control and Prevention, Yunnan, China

Jonas Tillman

Division of Intervention, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China

  

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