[Sex specific mortality in HIV/AIDS patients receiving antiretroviral therapy and risk factors in Xinjiang Uygur autonomous region]

Abstract

Objective: To analyze the sex specific mortality in HIV/AIDS patients receiving highly active antiretroviral therapy (HAART) and risk factors in Xinjiang Uyghur autonomous region (Xinjiang), and provide evidence for the evaluation of the effect of HAART.

Methods: A retrospective analysis was conducted on the mortality and survival of 8 061 male cases and 6 001 female cases of HIV infection, who received HAART during July 2004-June 2013 in Xinjiang. The information of the cases were downloaded from national antiretroviral therapy reporting sub-system in national HIV/AIDS reporting system. Cox proportional hazard model was used to identify the risk factors of deaths.

Results: The male cases were older and had lower CD4 value at baseline compared with the female cases. The major transmission route was injecting drug use in males, but sexual contact in females. The overall mortality of the male cases was higher than that of the females, which was 10.87/100 person-years during the first three month after receiving HAART, and 7.00/100 person-years two years later in males, but 4.77/100 person-years during the first three month and 3.00/100 person-years two years later in females. The results from Cox analysis showed that the risk factors were the CD4 value at baseline and transmission route. Compared with the cases who had lower CD4 value (CD4<200 cells/µl) at baseline, the HR for the cases who had higher CD4 value (CD4≥350 cells/µl) was 4.08 (95% CI: 2.96-5.62) in males and 5.11 (95% CI: 3.16-8.35) in females. Compared with sexual transmission, the HR for IDUs was 1.99 (95% CI: 1.66-2.40) in males and 1.77 (95% CI: 1.24-2.52) in females. The results of cumulative survival analysis showed that in conventional treatment group (CD4<350 cells/µl) , the five year survival rates were 81% and 87% for the males and females infected through sexual contact and 66% and 75% for the males and females infected through injecting drug use, and in early treatment group (CD4≥350 cells/µl) , the five year survival rates were 97% and 98% for the males and females infected through sexual contact and 86% and 97% for the males and females infected through injecting drug use.

Conclusion: In Xinjiang, the higher mortality in male HIV infection cases receiving HAART was related with lower CD4 value at baseline and higher infection rate through injecting drug use. Besides the weak intention for treatment and poor compliancy would be the deeper risk factors.