Immediate Antiretroviral Therapy Decreases Mortality Among Patients With High CD4 Counts in China: A Nationwide, Retrospective Cohort Study. (21st October 2017)

• Record Type: Journal Article
• Authors: Zhao, Yan; Wu, Zunyou; McGoogan, Jennifer M; Shi, Cynthia X; Li, Aihua; Dou, Zhihui; Ma, Ye; Qin, Qianqian; Brookmeyer, Ron; Detels, Roger; Montaner, Julio S G
• Is Part Of: Clinical infectious diseases. Volume 66:Number 5(2018)
• Page Start: 727
• Page End: 734
• Publication Date: 2017-10-21
• Subjects: HIV/AIDS -- antiretroviral therapy -- treatment initiation -- CD4 count -- mortality; Communicable diseases -- Periodicals; 616.905
• DOI: 10.1093/cid/cix878
• Languages: English
• ISSNs: 1058-4838

Abstract

Abstract : We enrolled 34581 individuals newly diagnosed with human immunodeficiency virus infection with CD4 cell counts >500 cells/μL and found that initiation of antiretroviral therapy within 30 days of diagnosis was associated with a 63% reduction in overall mortality at 12 months of follow-up. 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.