Effect of antiretroviral therapy initiation time and baseline CD4+ cell counts on AIDS-related mortality among former plasma donors in China: a 21-year retrospective cohort study

• Published in: Global health action Vol. 14; no. 1; p. 1963527
• Main Authors: Yang, Yongli, Li, Yang, Zhang, Xuening, Zhang, Weiping, Ma, Yanmin, Jia, Xiaocan, Gondwe, Theodore, Wang, Yuping, Shi, Xuezhong
• Format: Journal Article
• Language: English
• Published: Abingdon Taylor & Francis 01.01.2021; Taylor & Francis Ltd; Taylor & Francis Group
• Subjects: Acquired immune deficiency syndrome; AIDS; Antiretroviral agents; Antiretroviral therapy; CD4; cd4+ cell counts; cell counts; Cohort analysis; competing risk model; Competing risks models; Death & dying; Donors; Drug therapy; Health risks; High risk; HIV; HIV/AIDS; Human immunodeficiency virus; Immune response; Immune system; Medical diagnosis; Medical prognosis; Mortality; Mortality risk; Original; Survival analysis; treatment initiation; China
• ISSN: 1654-9716; 1654-9880
• DOI: 10.1080/16549716.2021.1963527

The conventional survival analysis model on HIV/AIDS prognosis is the Cox proportional hazard model, which deals with only one event type, death, regardless of the cause. Few studies have used a competing risk model to evaluate the predictors of AIDS-related mortality. To estimate the influence of antiretroviral therapy (ART) initiation time and baseline CD4 + cell counts on acquired immunodeficiency syndrome (AIDS)-related death among former plasma donors. A retrospective cohort study was conducted involving 11,905 human immunodeficiency virus (HIV) or AIDS patients in a high-risk area of Henan province in China between 1995 and 2016. Demographic and clinical data were collected. Sub-distribution hazard ratios (sHRs) for AIDS-related mortality with baseline CD4 + cell counts and ART initiation time were determined using a competing risk model. Patients who initiated ART within 90 days of HIV/AIDS diagnosis (sHR: 0.24, 95% CI: 0.22-0.27) or had baseline CD4 + counts of >500 cells/μL (sHR: 0.23, 95% CI: 0.19-0.28) were associated with lower AIDS-related mortality risk. Patients with ART initiation time >1 year but CD4 + counts >350 cells/μL (sHR: 4.42, 95% CI: 3.30-5.91) had a higher AIDS-related mortality risk than those with ART initiation time >90 days but CD4 + counts ≤350 cells/μL (sHR: 4.33, 95% CI: 3.58-5.23). Our results demonstrate that patients with high CD4 + cell counts and late ART had a 9% higher risk of AIDS-related death than those with low CD4 + cell counts and early ART. This study confirms the great significance of immediate ART initiation among former plasma donor HIV patients in China.