[Survival analysis on Former Plasma Donors living with HIV/AIDS after initiation of antiretroviral therapy in Henan province, 2002-2017]

Abstract

Objective: To explore the survival status and influencing factors on former plasma donors (FPD) living with HIV/AIDS after initiation of antiretroviral therapy (ART) during 2002-2017 in Henan province. Methods: A retrospective study was conducted, using data from the ART database of national comprehensive HIV/AIDS information system. The inclusion criteria on patients would include HIV/AIDS cases with current residence in Henan province, route of infection being blood-borne (plasma collection), initiation of ART between 2002 and 2017, and 15 year-olds or above. According to the time of initation on antiviral treatment, observation was carried on between January 1, 2002 and December 31, 2017. Outcome of observation was defined as death caused by AIDS or related diseases. Life Table was used to estimate the survival rate and Kaplan-Meier method was used to draw the survival curve. Log-rank test was used to compare the univariate intergroup survival rates while Cox proportional hazards regression model was used to analyze the influencing factors on survival status among deaths due to AIDS or related diseases. Excel 2010 software and SPSS 23.0 software was used for data cleaning and statistical analysis. Results: A total of 25 825 HIV/AIDS patients were enrolled in this study. During the follow-up period, the overall mortality was 3.9/100 person year (8 354/214 796.3), among all the patients. The accumulate survival rates of 1 year, 4 years, 8 years, 12 years and 16 years after the initiation of ART were 91.2%, 80.1%, 71.2%, 65.7% and 61.5%, respectively. The results from the multivariate Cox proportional hazards regression model analysis showed that male vs. female (aHR=1.46, 95%CI: 1.39-1.53); aged 45-49 years group and aged 60 and older years group of initiating ART vs. aged 15-44 years group of initiating ART respectively (aHR=1.47, 95%CI: 1.40-1.54; aHR=2.50, 95%CI: 2.22-2.81); other marital status vs. being married or under cohabitation (aHR=1.29, 95%CI: 1.21-1.36); baseline CD(4)(+)T cells counts (CD(4))<50, 50-199 and 200-349 cells/μl respectively vs. baseline CD(4)≥350 cells/μl (aHR=4.50, 95%CI: 4.14- 4.89; aHR=2.49, 95%CI: 2.31-2.69; aHR=1.44, 95%CI: 1.33-1.56); number of opportunistic infections at baseline were one case, 2-3 cases and 4-5 cases respectively vs. non opportunistic infections cases at baseline (aHR=1.17, 95%CI: 1.06-1.29; aHR=1.47, 95%CI: 1.35-1.59; aHR=1.74, 95%CI: 1.60-1.89); taking TMP-SMZ vs. not taking TMP-SMZ (aHR=0.69, 95%CI: 0.65- 0.73). Conclusions: The 16-year accumulate survival rate was 61.5% among FPD living with HIV/AIDS after initiation of ART, during 2002 to 2017 in Henan province. The risk factors for FPD death case would include: being males, aged 45 and older years at the initiation of ART, baseline CD(4)<350 cells/μl and the number of baseline opportunistic infections cases ≥1. The protective factors on FPD death appeared as: being married or cohabited as wel as on TMP-SMZ.

Keywords: Antiretroviral therapy; Former plasma donation; HIV/AIDS; Survival analysis.