This study assesses
association between CD4 level at initiation of antiretroviral treatment (ART)
on subsequent treatment outcomes and mortality among people infected with HIV
via various routes in Hunan province, China.
Over a period of 10 years, a total of 7333 HIV-positive patients, including 553 (7.5%) MSM, 5484 (74.8%) heterosexuals, 1164 (15.9%) injection drug users (IDU) and 132 (1.8%) former plasma donors (FPD), were recruited.
MSM substantially demonstrated higher initial CD4 cell level (242, IQR 167-298) than other populations (Heterosexuals: 144 IQR 40-242, IDU: 134 IQR 38-224, FPD: 86 IQR 36-181). During subsequent long-term follow up, the median CD4 level in all participants increased significantly from 151 cells/mm³ (IQR 43-246) to 265 cells/mm³ (IQR 162-380), whereas CD4 level in MSM remained at a high level between 242 and 361 cells/mm³.
Consistently, both cumulative immunological and virological failure rates (10.4% and 26.4% in 48 months, respectively) were the lowest in MSM compared with other population groups. Survival analysis indicated that initial CD4 counts ≤200 cells/mm³ (AHR = 3.14; CI, 2.43-4.06) significantly contributed to HIV-related mortality during treatment.
Timely diagnosis and treatment of HIV patients are vital for improving CD4 level and health outcomes.
Over a period of 10 years, a total of 7333 HIV-positive patients, including 553 (7.5%) MSM, 5484 (74.8%) heterosexuals, 1164 (15.9%) injection drug users (IDU) and 132 (1.8%) former plasma donors (FPD), were recruited.
MSM substantially demonstrated higher initial CD4 cell level (242, IQR 167-298) than other populations (Heterosexuals: 144 IQR 40-242, IDU: 134 IQR 38-224, FPD: 86 IQR 36-181). During subsequent long-term follow up, the median CD4 level in all participants increased significantly from 151 cells/mm³ (IQR 43-246) to 265 cells/mm³ (IQR 162-380), whereas CD4 level in MSM remained at a high level between 242 and 361 cells/mm³.
Consistently, both cumulative immunological and virological failure rates (10.4% and 26.4% in 48 months, respectively) were the lowest in MSM compared with other population groups. Survival analysis indicated that initial CD4 counts ≤200 cells/mm³ (AHR = 3.14; CI, 2.43-4.06) significantly contributed to HIV-related mortality during treatment.
Timely diagnosis and treatment of HIV patients are vital for improving CD4 level and health outcomes.
Full PDF article at: http://goo.gl/kZOkua Abstract: http://goo.gl/5QL8eJ
- 1Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC 3004, Australia. ssu27@student.monash.edu.
- 2School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC 3004, Australia. ssu27@student.monash.edu.
- 3Hunan Provincial Center for Disease Control and Prevention, Changsha 410005, Hunan, China. chenxi161@sohu.com.
- 4Center for Social Research in Health, Faculty of Arts and Social Science at the University of New South Wales, Sydney, NSW 2052, Australia. limin.mao@unsw.edu.au.
- 5Hunan Provincial Center for Disease Control and Prevention, Changsha 410005, Hunan, China. jmhe69@126.com.
- 6Hunan Provincial Center for Disease Control and Prevention, Changsha 410005, Hunan, China. isqq2011@163.com.
- 7Comprehensive AIDS Research Center, Tsinghua University, Beijing 100084, China. jingjun@tsinghua.edu.cn.
- 8Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC 3004, Australia. lei.zhang1@monash.edu.
- 9School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC 3004, Australia. lei.zhang1@monash.edu.
- 10Comprehensive AIDS Research Center, Tsinghua University, Beijing 100084, China. lei.zhang1@monash.edu.
- 11Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC 3004, Australia. lei.zhang1@monash.edu.
- Int J Environ Res Public Health. 2016 Mar 8;13(3). pii: E283. doi: 10.3390/ijerph13030283.
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