Effect of earlier initiation of antiretroviral treatment and increased treatment coverage on HIV-related mortality in China: a national observational cohort study

被引:269
作者
Zhang, Fujie [1 ,2 ]
Dou, Zhihui [1 ]
Ma, Ye [1 ]
Zhang, Yao [1 ]
Zhao, Yan [1 ]
Zhao, Decai [1 ]
Zhou, Shuntai [1 ]
Bulterys, Marc [3 ]
Zhu, Hao [1 ,5 ]
Chen, Ray Y. [4 ]
机构
[1] Chinese Ctr Dis Control & Prevent, Natl Ctr AIDS STD Control & Prevent, Beijing, Peoples R China
[2] Capital Med Univ, Ditan Hosp, Beijing, Peoples R China
[3] US Ctr Dis Control & Prevent, Global AIDS Program, Beijing, Peoples R China
[4] NIAID, US Natl Inst Hlth, Beijing, Peoples R China
[5] Univ N Carolina, Chapel Hill, NC USA
关键词
RAPID SCALE-UP; PUBLIC-HEALTH; LOW-INCOME; THERAPY; CARE; INFECTION; MORBIDITY; ACCESS; STATES;
D O I
10.1016/S1473-3099(11)70097-4
中图分类号
R51 [传染病];
学科分类号
100401 ;
摘要
Background Overall HIV mortality rates in China have not been reported. In this analysis we assess overall mortality in treatment-eligible adults with HIV and attempt to identify risk factors for HIV-related mortality. Methods We used data from the national HIV epidemiology and treatment databases to identify individuals aged 15 years or older with HIV who were eligible for highly active antiretroviral therapy between 1985 and 2009. Mortality rates were calculated in terms of person-years, with risk factors determined by Cox proportional hazard regression. Treatment coverage was calculated as the proportion of time that patients who were eligible for treatment received treatment, with risk factors for not receiving treatment identified by use of logistic regression. Findings Of 323 252 people reported as having HIV in China by the end of 2009, 145 484 (45%) were identified as treatment-eligible and included in this analysis. Median CD4 count was 201 cells per mu L (IQR 71-315) at HIV diagnosis and 194 cells per mu L (73-293) when first declared eligible for treatment. Overall mortality decreased from 39.3 per 100 person-years in 2002 to 14.2 per 100 person-years in 2009, with treatment coverage concomitantly increasing from almost zero to 63.4%. By 2009, mortality was higher and treatment coverage lower in injecting drug users (15.9 deaths per 100 person-years; 42.7% coverage) and those infected sexually (17.5 deaths per 100 person-years; 61.7% coverage), compared with those infected through plasma donation or blood transfusion (6.7 deaths per 100 person-years; 80.2% coverage). The two strongest risk factors for HIV-related mortality were not receiving highly active antiretroviral therapy (adjusted hazard ratio 4.35, 95% CI 4.10-4.62) and having a CD4 count of less than 50 cells per mu L when first declared eligible for treatment (7.92, 7.33-8.57). Interpretation An urgent need exists for earlier HIV diagnosis and better access to treatment for injecting drug users and patients infected with HIV sexually, especially before they become severely immunosuppressed.
引用
收藏
页码:516 / 524
页数:9
相关论文
共 46 条
[1]  
Adam MA, 2009, SAMJ S AFR MED J, V99, P661
[2]   Late Presentation for Human Immunodeficiency Virus Care in the United States and Canada [J].
Althoff, Keri N. ;
Gange, Stephen J. ;
Klein, Marina B. ;
Brooks, John T. ;
Hogg, Robert S. ;
Bosch, Ronald J. ;
Horberg, Michael A. ;
Saag, Michael S. ;
Kitahata, Mari M. ;
Justice, Amy C. ;
Gebo, Kelly A. ;
Eron, Joseph J. ;
Rourke, Sean B. ;
Gill, M. John ;
Rodriguez, Benigno ;
Sterling, Timothy R. ;
Calzavara, Liviana M. ;
Deeks, Steven G. ;
Martin, Jeffrey N. ;
Rachlis, Anita R. ;
Napravnik, Sonia ;
Jacobson, Lisa P. ;
Kirk, Gregory D. ;
Collier, Ann C. ;
Benson, Constance A. ;
Silverberg, Michael J. ;
Kushel, Margot ;
Goedert, James J. ;
McKaig, Rosemary G. ;
Van Rompaey, Stephen E. ;
Zhang, Jinbing ;
Moore, Richard D. .
CLINICAL INFECTIOUS DISEASES, 2010, 50 (11) :1512-1520
[3]   Implementing antiretroviral therapy in rural communities: The Lusikisiki model of decentralized HIV/AIDS care [J].
Bedelu, Martha ;
Ford, Nathan ;
Hilderbrand, Katherine ;
Reuter, Hermann .
JOURNAL OF INFECTIOUS DISEASES, 2007, 196 :S464-S468
[4]   Monitoring the scale-up of antiretroviral therapy programmes: methods to estimate coverage [J].
Boerma, JT ;
Stanecki, KA ;
Newell, ML ;
Luo, C ;
Beusenberg, M ;
Garnett, GP ;
Little, K ;
Calleja, JG ;
Crowley, S ;
Kim, JY ;
Zaniewski, E ;
Walker, N ;
Stover, J ;
Ghys, PD .
BULLETIN OF THE WORLD HEALTH ORGANIZATION, 2006, 84 (02) :145-150
[5]  
Braitstein P, 2006, LANCET, V367, P817, DOI 10.1016/S0140-6736(06)68337-2
[6]   A public health approach to rapid scale-up of free antiretroviral treatment in China: an ounce of prevention is worth a pound of cure [J].
Bulterys, Marc ;
Vermund, Sten H. ;
Chen, Ray Y. ;
Ou, Chin-Yih .
CHINESE MEDICAL JOURNAL, 2009, 122 (11) :1352-1355
[7]   Decreases in Community Viral Load Are Accompanied by Reductions in New HIV Infections in San Francisco [J].
Das, Moupali ;
Chu, Priscilla Lee ;
Santos, Glenn-Milo ;
Scheer, Susan ;
Vittinghoff, Eric ;
McFarland, Willi ;
Colfax, Grant N. .
PLOS ONE, 2010, 5 (06)
[8]   Changing baseline characteristics among patients in the China National Free Antiretroviral Treatment Program, 2002-09 [J].
Dou, Zhihui ;
Chen, Ray Y. ;
Xu, Jiahong ;
Ma, Ye ;
Jiao, Jin Hua ;
Durako, Stephen ;
Zhao, Yan ;
Zhao, Decai ;
Fang, Hua ;
Zhang, Fujie .
INTERNATIONAL JOURNAL OF EPIDEMIOLOGY, 2010, 39 :II56-II64
[9]   HIV-Infected Former Plasma Donors in Rural Central China: From Infection to Survival Outcomes, 1985-2008 [J].
Dou, Zhihui ;
Chen, Ray Y. ;
Wang, Zhe ;
Ji, Guoping ;
Peng, Guoping ;
Qiao, Xiaochun ;
Fu, Jihua ;
Meng, Xiangdong ;
Bulterys, Marc ;
Ma, Ye ;
Zhao, Yan ;
Wang, Ning ;
Zhang, Fujie .
PLOS ONE, 2010, 5 (10)
[10]   Scaling up of highly active antiretroviral therapy in a rural district of Malawi: an effectiveness assessment [J].
Ferradini, L ;
Jeannin, A ;
Pinoges, L ;
Izopet, J ;
Odhiambo, D ;
Mankhambo, L ;
Karungi, G ;
Szumilin, E ;
Balandine, S ;
Fedida, G ;
Carrieri, MP ;
Spire, B ;
Ford, N ;
Tassie, JM ;
Guerin, PI ;
Brasher, C .
LANCET, 2006, 367 (9519) :1335-1342