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Observational Study
. 2020 Jul 17;17(1):44.
doi: 10.1186/s12981-020-00300-4.

Effect of AIDS-defining events at initiation of antiretroviral therapy on long-term mortality of HIV/AIDS patients in Southwestern China: a retrospective cohort study

Yunxuan Huang  1 , Oulu Zhou  2   3 , Zhigang Zheng  3 , Yuexiang Xu  1 , Yi Shao  4 , Chunwei Qin  1 , Fengxiang Qin  3 , Jingzhen Lai  3 , Huifang Liu  3 , Rongfeng Chen  2   3 , Li Ye  3 , Hao Liang  2   3 , Xionglin Qin  5 , Junjun Jiang  6
Affiliations
Observational Study

Effect of AIDS-defining events at initiation of antiretroviral therapy on long-term mortality of HIV/AIDS patients in Southwestern China: a retrospective cohort study

Yunxuan Huang et al. AIDS Res Ther. .

Abstract

Objective: To evaluate the impact of AIDS-defining events (ADE) on long-term mortality of HIV positive individuals on antiretroviral therapy (ART), a retrospective HIV/AIDS treatment cohort study performed in Southwestern China.

Methods: The retrospective cohort was conducted among 6757 HIV/AIDS patients on ART (2NRTIs + 1NNRTI, 2NRTIs + 1PI and Single or two drugs) recruited in Guigang city, Guangxi, China, from January 2004 to December 2018. Participants were divided into ADE and non-ADE groups, and were followed-up every six months to observe treatment outcomes. Comparison of mortality between groups was performed using the log-rank test and Kaplan-Meier analysis. Cox proportional hazard regression was used to explore the risk factors of mortality. 1:1 propensity score matching (PSM) was used to balance confounding factors and adjust the mortality risk.

Results: Of 6757 participants with 29,096.06 person-years of follow-up, 16.86% (1139/6757) belonged to ADE group while the others (83.14%) belonged to the non-ADE group. The most common cause of death by ADE was disseminated mycosis (31.65%), followed by recurrent severe bacterial pneumonia (28.48%), herpes zoster (17.72%), and extra-pulmonary tuberculosis (8.86%). The mortality of the ADE group was significantly higher than that of the non-ADE group [3.45/100 person-years (95% CI 2.92-3.97) vs. 2.34/100 person-years (95% CI 2.15-2.52), P<0.001]. The death risk of the ADE group was also higher than that of the non- ADE group [adjusted hazard ratio (aHR) = 1.291, 95% CI 1.061-1.571, P = 0.011], which was confirmed by PSM analysis (aHR = 1.581, 95% CI 1.192-2.099, P = 0.002). Cox analysis indicated that ADE, older age, male gender, previous non-use of cotrimoxazole, advanced WHO clinical stage, and low baseline CD4+ cell count were the risk factors for death.

Conclusions: Even on ART, the mortality risk of HIV positive individuals with ADE was higher than those without ADE. Active testing, earlier diagnosis, and timely therapy with ART may reduce the death risk of ADE.

Keywords: AIDS; AIDS-defining events; Antiretroviral therapy; HIV; Mortality.

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Conflict of interest statement

The authors declare that they have no financial conflicts of interest.

Figures

Fig. 1
Fig. 1
Flow charts of inclusion and exclusion criteria for research subjects in this study
Fig. 2
Fig. 2
Kaplan-Meier analysis of cumulative mortality of HIV/AIDS patients, grouped by ADE (The log-rank test was used for statistical)
See this image and copyright information in PMC

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