Long-Term Effectiveness of Antiretroviral Therapy in China: An Observational Cohort Study from 2003-2014

In order to assess the effectiveness of the Chinese government's expanded access program, a cohort study on all adult HIV patients in Shenzhen was conducted from December 2003 to February 2014 to estimate the effects of antiretroviral therapy (ART) on mortality, tuberculosis and CD4 cell counts. Marginal structural regression models adjusted for baseline and time-varying covariates. Of the 6897 patients enrolled and followed up for a maximum of 178 months, 44.92% received ART. Among patients who commenced receiving ART during the study, there were 98 deaths and 59 new tuberculosis diagnoses, while there were 410 deaths and 201 new tuberculosis diagnoses among those without ART. ART was associated with both lower mortality (hazard ratio [HR] = 0.18; 95% confidence interval [CI] = 0.11-0.27) and the presence of tuberculosis (HR = 0.27; 95% CI = 0.19-0.37). Each month of ART was associated with an average increase in CD4 cell count of 6.52 cells/mu L (95% CI = 6.08-7.12 cells/mu L). In conclusions, the effectiveness of ART provided by China government health services is the same as that in higher-income countries. Accounting to higher mortality rates from the delay of starting ART, faster expansion and timely imitation of ART are urgent.