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Observational Study
. 2018 Feb 10;66(5):727-734.
doi: 10.1093/cid/cix878.

Immediate Antiretroviral Therapy Decreases Mortality Among Patients With High CD4 Counts in China: A Nationwide, Retrospective Cohort Study

Yan Zhao  1 , Zunyou Wu  1   2 , Jennifer M McGoogan  1 , Cynthia X Shi  1   3 , Aihua Li  1 , Zhihui Dou  1 , Ye Ma  1 , Qianqian Qin  1 , Ron Brookmeyer  4 , Roger Detels  2 , Julio S G Montaner  5
Affiliations
Observational Study

Immediate Antiretroviral Therapy Decreases Mortality Among Patients With High CD4 Counts in China: A Nationwide, Retrospective Cohort Study

Yan Zhao et al. Clin Infect Dis. .

Abstract

Background: Clinical trials have demonstrated that immediate initiation of antiretroviral therapy (ART) reduces AIDS-related morbidity and mortality. We tested the hypothesis that initiating ART ≤30 days after human immunodeficiency virus (HIV) diagnosis would be associated with reduced mortality among people living with HIV (PLWH) with CD4 counts >500 cells/μL.

Methods: PLWH enrolled in the Chinese National HIV Information System between January 2012 and June 2014 with CD4 counts >500 cells/μL were followed for 12 months. Cox proportional hazards model was used to determine hazard ratios (HRs) for PLWH who initiated ART after HIV diagnosis. ART initiation was treated as a time-dependent variable.

Results: We enrolled 34581 PLWH with CD4 >500 cells/μL; 1838 (5.3%) initiated ART ≤30 days after diagnosis (immediate ART group), and 19 deaths were observed with a mortality rate of 1.04 per 100 person-years (PY). Fifty-eight deaths were documented among the 5640 PLWH in the delayed ART group with a mortality rate of 2.25 per 100 PY. There were 713 deaths among the 27103 PLWH in the no ART group with a mortality rate of 2.39 per 100 PY. After controlling for potential confounding factors, ART initiation at ≤30 days (adjusted HR, 0.37 [95% confidence interval, .23-.58]) was a statistically significant protective factor.

Conclusions: We found that immediate ART is associated with a 63% reduction in overall mortality among PLWH with CD4 counts >500 cells/μL in China, supporting the recommendation to initiate ART immediately following HIV diagnosis.

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Figures

Figure 1.
Figure 1.
Flow diagram depicting study design and development of the cohort. Abbreviations: ART, antiretroviral therapy; HIV, human immunodeficiency virus.
See this image and copyright information in PMC

Comment in

  • High Baseline CD4 Counts and Antiretroviral Therapy Cessation.
    Pan SW, Shen Z, Xing H, Ruan Y, Shao Y. Pan SW, et al. Clin Infect Dis. 2018 Aug 1;67(4):644. doi: 10.1093/cid/ciy131. Clin Infect Dis. 2018. PMID: 29462265 No abstract available.
  • Reply to Pan et al.
    Zhao Y, Wu Z, McGoogan JM. Zhao Y, et al. Clin Infect Dis. 2018 Aug 1;67(4):644-645. doi: 10.1093/cid/ciy133. Clin Infect Dis. 2018. PMID: 29462267 No abstract available.

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