Causes of Death among AIDS Patients after Introduction of Free Combination Antiretroviral Therapy (cART) in Three Chinese Provinces, 2010–2011

Wang, Liyan; Lin, Guo‐Qiang; Wang, Lu; Morano, Jamie P.; Guo, Wei; Khoshnood, Kaveh; Qin, Qianqian; Ding, Zhengwei; Sun, Dingyong; Liu, Xiaoyan; Luo, Hongbing; Tillman, Jonas; Cui, Yan

doi:10.1371/journal.pone.0139998

Cited by 5 publications

(5 citation statements)

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“…Second, we did not analyze the impact of late ART initiation on the outcome of HIV-positive patients because of the unavailability of follow-up data. However, many other studies [ 1 , 8 , 9 ] have demonstrated that the late initiation of ART significantly weakens its effect. Thirdly, those patients with missing CD4 cell count were excluded out of this study and it might result in selection bias.…”

Section: Discussionmentioning

confidence: 99%

“…What even worse is that many HIV-positive people receive late HIV diagnoses [5–7]. Both of these factors weaken the effect of ART among HIV-positive populations [8, 9]. Therefore, the vital steps to maximize the efficacy of ART for HIV infected patients would be expanding screening of HIV antibody and initiating ART as soon as possible when the patients meet the criteria [10].…”

Section: Introductionmentioning

confidence: 99%

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Trends in baseline CD4 cell counts and risk factors for late antiretroviral therapy initiation among HIV-positive patients in Shanghai, a retrospective cross-sectional study

et al. 2017

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BackgroundsThere are few studies focus on the factors underlying the late initiation of ART in China. We analyzed the trends in the median CD4 cell counts among different patient groups over time and the risk factors for the late initiation of ART in Shanghai, China.MethodsA retrospective cross-sectional survey was made in the Department of Infectious Disease of Shanghai Public Health Clinical Center which is a designated diagnosis and treatment center for HIV-positive patients in Shanghai during the period of January 1st, 2008--June 30th, 2014. Late ART initiation was defined as a CD4 cell count <200 cells/mm3 or having a clinical AIDS diagnosis prior to ART initiation. Trends in the median CD4 cell count at ART initiation and the proportion of late ART initiation by year were evaluated using Spearman’s correlations and Chi-squared methods, respectively. We used a logistic regression model to analyze the risk factors for late ART initiation. The related factors collected in the multivariate model were the patient’s age, gender, infection routes and marital status.ResultsA total of 3796 patients were analyzed in this study, with a median baseline CD4 cell count of 205 cells/mm3 [interquartile range: 75–287]. The median CD4 cell counts of patients initiating ART late increased from 76 cells/mm3 in 2008 to 103 cells/mm3 in 2014 (p < 0.001), and the proportion of late ART initiation decreased from 80% to 45% (p < 0.001). The risk factors for late ART initiation were male gender, heterosexual transmission and older age (>30 years) (p < 0.001).ConclusionsNotable improvements were made in the median CD4 cell count at ART initiation and the proportion of late ART initiation from 2008 to 2014. However, persons with high risk of HIV exposure who are male, older even heterosexual orientation should be given more opportunities to receive frequently screening, earlier diagnoses and timely treatment.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-017-2398-5) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Trends in baseline CD4 cell counts and risk factors for late antiretroviral therapy initiation among HIV-positive patients in Shanghai, a retrospective cross-sectional study

et al. 2017

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“…All HIV-1-infected subjects were examined by medical screening, and voluntarily received cART. The treatment regimen and algorithm TDF+3TC+EFV (17 patients) or AZT+3TC+NVP (1 patient) were carried out according to the China free cART manual [ 29 ], in which the threshold for cART eligibility was recommend as CD4+ T cells < 350/μL [ 30 ] and suggested therapy regimen was AZT/d4T+3TC+NVP/EFV.…”

Section: Methodsmentioning

confidence: 99%

Combination antiretroviral therapy (cART) restores HIV-1 infection-mediated impairment of JAK-STAT signaling pathway

Liu

Zhao²,

Kong

et al. 2017

Oncotarget

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JAK-STAT signaling pathway has a crucial role in host innate immunity against viral infections, including HIV-1. We therefore examined the impact of HIV-1 infection and combination antiretroviral therapy (cART) on JAK-STAT signaling pathway. Compared to age-matched healthy donors (n = 18), HIV-1-infected subjects (n = 18) prior to cART had significantly lower expression of toll-like receptors (TLR-1/4/6/7/8/9), the IFN regulatory factors (IRF-3/7/9), and the antiviral factors (OAS-1, MxA, A3G, PKR, and Tetherin). Three months’ cART partially restores the impaired functions of JAK-STAT-mediated antiviral immunity. We also found most factors had significantly positive correlations (p < 0.05) between each two factors in JAK-STAT pathway in healthy donors (98.25%, 168/171), but such significant positive associations were only found in small part of HIV-1-infected subjects (43.86%, 75/171), and stably increased during the cART (57.31%, 98/171 after 6 months’ cART). With regard to the restoration of some HIV-1 restriction factors, HIV-1-infected subjects who had CD4+ T cell counts > 350//μl responded better to cART than those with the counts < 350/μl. These findings indicate that the impairment of JAK-STAT pathway may play a role in the immunopathogenesis of HIV-1 disease.

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“…For reasons that remain poorly defined, long-term treated HIV-infected persons have an expected life span that is substantially shorter than that of their HIV-uninfected peers 7–10 . This shortened life span is largely due to an increased risk of some “non-AIDS” complications, encompassing heart disease, cancer, liver disease, kidney disease, bone disease, and neurocognitive decline 8 many of which complications are similar to that observed generally among the elderly. In addition, the fact of these diseases are degenerative in nature will affect the quality of life and functionality.…”

Section: Introductionmentioning

confidence: 97%

“…Despite the unquestioned success, combination antiretroviral therapy does not fully restore health. For reasons that remain poorly defined, long-term treated HIV-infected persons have an expected life span that is substantially shorter than that of their HIV-uninfected peers [7][8][9][10] . This shortened life span is largely due to an increased risk of some "non-AIDS" complications, encompassing heart disease, cancer, liver disease, kidney disease, bone disease, and neurocognitive decline 8 many of which complications are similar to that observed generally among the elderly.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of Tenofovir-based regimen in elderly people living with HIV in sub-Saharan Africa: A systematic review and meta-analysis

Akinsolu

Ekama

Musa

et al. 2022

Preprint

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Objective The study examined whether the benefit and adverse effects of the tenofovir-based highly active antiretroviral therapy (HAART) regimen outweigh the non-tenofovir-based regimen in the elderly population. Methods We searched PubMed, EMBASE, Cochrane Central Library, Google Scholar, and some hand searches to identify eligible studies. Only randomized control trials on elderly HIV-positive patients on Tenofovir-based regimens living in sub-Saharan Africa were included. Studies on pregnant women or prophylactic tenofovir were excluded. The primary outcomes are viral suppression, mortality, and anemia. Two reviewers independently selected the studies, extracted data, and assessed the risk of bias. We analyzed using risk ratio, with 95% confidence intervals. A fixed effect model along with an assessment of heterogeneity was done for meta-analysis. Results Four studies with a total of 263 participants were included. Our meta-analysis shows that there was no difference between participants on a tenofovir-based regimen and the non-tenofovir-based regimen in terms of viral suppression, mortality, anemia, and hypertension. Our meta-analysis shows that there was no difference between participants on tenofovir based regimen and non-tenofovir based regimen in terms of viral suppression (RR=1.96, 95% CI (1.42 -2.70; I2=0%, 4 trials, 263 participants, very low certainty of evidence), mortality (RR = 2.90, 95% CI (0.12 – 69.87, I2=Not estimated, a trial, 120 participants, very low certainty of evidence), anaemia (RR=1.61, 95% CI (1.02-2.90; I2 = 0.16, 2 trials, 154 participants, very low certainty of evidence), hypertension RR = 0.76, 95% CI (0.44-1.31) I2 = Not estimated, a trial, 34 participants, low-certainty of evidence). None of the trials reported the incidence of chronic kidney disease and bone demineralization. Conclusion There was very-low certainty evidence that no difference exists between the tenofovir-based HAART regimen and the non-tenofovir-based regimen in terms of benefits and short-term adverse outcomes. Well-designed randomized clinical trials are needed with a focus on long-term adverse effects.

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Causes of Death among AIDS Patients after Introduction of Free Combination Antiretroviral Therapy (cART) in Three Chinese Provinces, 2010–2011

Cited by 5 publications

References 16 publications

Trends in baseline CD4 cell counts and risk factors for late antiretroviral therapy initiation among HIV-positive patients in Shanghai, a retrospective cross-sectional study

Trends in baseline CD4 cell counts and risk factors for late antiretroviral therapy initiation among HIV-positive patients in Shanghai, a retrospective cross-sectional study

Combination antiretroviral therapy (cART) restores HIV-1 infection-mediated impairment of JAK-STAT signaling pathway

Efficacy and safety of Tenofovir-based regimen in elderly people living with HIV in sub-Saharan Africa: A systematic review and meta-analysis

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