Effect of AIDS-defining events at initiation of antiretroviral therapy on long-term mortality of HIV/AIDS patients in Southwestern China: a retrospective cohort study

Huang, Yunxuan; Zhou, Oulu; Zheng, Zhigang; Xu, Yuyan; Shao, Yi; Qin, Chunwei; Qin, Fengxiang; Lai, Jingzhen; Liu, Huifang; Chen, Rongfeng; Li, Ye; Liang, Hao; Qin, Xionglin; Jiang, Junjun

doi:10.1186/s12981-020-00300-4

Cited by 6 publications

(5 citation statements)

References 42 publications

(38 reference statements)

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“…Since the identification of the first individual infected with HIV in Guangxi in 1996 [ 2 ], the number of infected individuals has increased. By the end of 2017, Guangxi has the second highest number of reported HIV cases (113,500) in the country [ 3 ]. The Free Antiretroviral Treatment Program was launched in 2003 in China, and the “Treat for All” policy was implemented in 2016, and under which HIV-positive individuals were treated after being diagnosis of HIV regardless of their CD4+ cell count [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

HIV drug resistance and HIV transmission risk factors among newly diagnosed individuals in Southwest China

Pang

Tang

et al. 2021

BMC Infect Dis

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Background The widespread use of antiretroviral therapy (ART) has resulted in the development of transmitted drug resistance (TDR), which reduces ART efficacy. We explored TDR prevalence and its associated risk factors in newly diagnosed individuals in Guangxi. Methods We enrolled 1324 participants who were newly diagnosed with HIV-1 and had not received ART at voluntary counselling and testing centres (VCT) in Guangxi, China, who had not received ART. Phylogenetic relationship, transmission cluster, and genotypic drug resistance analyses were performed using HIV-1 pol sequences. We analysed the association of demographic and virological factors with TDR. Results In total, 1151 sequences were sequenced successfully, of which 83 (7.21%) showed evidence of TDR. Multivariate logistic regression analysis revealed that there was significant difference between the prevalence of TDR and unmarried status (adjusted odds ratio (aOR) = 2.41, 95% CI: 1.23–4.71), and CRF08_BC subtype (aOR = 2.03, 95% CI: 1.13–3.64). Most cases of TDR were related to resistance to non-nucleoside reverse transcriptase inhibitors (4.87%) and V179E was the most common mutation detected. We identified a total of 119 HIV transmission clusters (n = 585, 50.8%), of which 18 (15.1%) clusters showed evidence of TDR (36, 41.86%). Three clusters were identified that included drug-resistant individuals having a transmission relationship with each other. The following parameters were associated with TDR transmission risk: Unmarried status, educational level of junior high school or below, and CRF08_BC subtype may be a risk of the transmission of TDR. Conclusions Our findings indicated that moderate TDR prevalence and highlighted the importance of continuous TDR monitoring and designing of strategies for TDR mitigation.

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Section: Introductionmentioning

confidence: 99%

HIV drug resistance and HIV transmission risk factors among newly diagnosed individuals in Southwest China

Pang

Tang

et al. 2021

BMC Infect Dis

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“…In our study, osteoarticular surgery was indicated for up to 43.5% of HIV/AIDS patients with 17 infectious and noninfectious diseases, including ICD-10 codes A18.007 + M49.0*, M87.800 × 051, and S72.000; these codes correspond to Pot’s disease (tuberculosis spondylitis), ischemic necrosis of the femoral head, and femoral fracture, respectively. Epidemiological data from Guangxi indicated that the proportion of HIV/AIDS patients with concurrent extrapulmonary tuberculosis was 8.86% ( Huang et al, 2020 ); meanwhile, AIDS unrelated diseases and fractures also accounted for a large proportion of these orthopedic surgery cases. As a result, the proportion of osteoarticular surgeries is higher in our data.…”

Section: Discussionmentioning

confidence: 99%

The association between serum CD4 T lymphocyte counts and surgical outcomes in HIV/AIDS patients in Guangxi, China: a retrospective cohort study

Liu

Deng

et al. 2021

PeerJ

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Background HIV/AIDS is a chronic disease leading to complications in infected individuals that often require surgical intervention. These patients’ serum CD4 T lymphocyte (CD4) counts represent one of the most important indicators of their ability to tolerate surgical treatment. Previous studies have demonstrated that CD4 cell count (CD4-CC) < 200 cells/μl may increase the risk of surgical complications in these patients, limiting their ability to undergo surgery, which may negatively affect their quality of life. Further investigation into the surgical outcomes of patients with CD4-CC < 200 cells/μl should provide guidance in making appropriate clinical decisions for the optimal healthcare of this patient demographic. Methods All enrolled patients were selected from 14 prefecture-level general hospitals in Guangxi, China, and were referred to AIDS outpost hospitals for inpatient surgical therapy. A total cohort of 168 adult patients was retrospectively analyzed. Multifactorial and stratified analyses were performed to evaluate the in surgical outcome differences for patients with CD4-CC < 200 cells/μl (N = 43), using those with CD4-CC ≥ 200 cells/μl (N = 125) as controls. Results Poor incisional healing was used as the primary outcome indicator, and postoperative complications were used as the secondary outcome indicator. In the patient group with CD4-CC < 200 cells/μl, the risk of surgical complications was significantly increased (OR 2.379; 95% CI [1.049–5.394]) after adjustment. Adjusted stratified analysis of the CD4-CC < 200 cells/μl group revealed that individuals over 60 years (OR 27.504; 95% CI [2.297–329.317]) with erythrocyte counts below 4.00/ml for males or 3.50/ml for females (OR 3.353; 95% CI [1.079–10.419]) had a significantly higher risk of postoperative complications; this finding was statistically different from the control (CD4 ≥ 200 cells/μl) group. However, there was no significant difference between the two groups regarding the risk of poorly healed incision outcomes. Conclusions Preliminary findings suggest that a serum CD4-CC < 200 cells/μl is not a definitive contraindication for surgical therapy and that baseline and surgical characteristics may help predict surgical outcomes in these patients. Further studies are needed to confirm these findings.

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“…5 Some of the other factors that are associated with survival outcomes in children on ART are age and gender of the child, type of setting (such as resource rich or resource limited), nutritional status of the child and presence of AIDS-defining illness. [6][7][8][9] Another important factor that needs to be considered is adherence to medications. Adherence in children may depend on the type of Open access regimen, demographic and clinical characteristics of children, and even the knowledge about ART and characteristics of their caregivers.…”

Section: Introductionmentioning

confidence: 99%

Retrospective cohort analysis of survival of children living with HIV/AIDS in Mumbai, India

Acharya

Palkar

Sayed³

et al. 2021

BMJ Open

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ObjectivesTo understand the survival in a cohort of children living with HIV/AIDS (CLHAs) and to study the factors associated with survival in CLHAs in government antiretroviral therapy (ART) centres in Mumbai, India.DesignThis is a retrospective cohort analysis.SettingData from electronic ART records of children from 15 ART centres in Mumbai, Maharashtra, India.Participants2224 CLHAs registered in one of these ART centres from 2004 until October 2019. CLHAs up to the age of 18 at the time of registration were considered for these analyses.Primary and secondary outcomesWe accessed the following data: date of test, date of initiation of ART, date of last follow-up, age at the time of registration, gender, potential route of infection, baseline CD4 counts, ART regimen, adherence and presence of co-infection (TB). We estimated the survival probabilities, plotted the Kaplan-Meier survival graphs and estimated HRs for mortality.ResultsThe mortality rate in our population was 22.75 (95% CI 20.02 to 25.85) per 1000 person-years. The 1-year survival was 0.92 (95% CI 0.91 to 0.93), 0.89 (95% CI 0.88 to 0.91) at 5 years and 0.85 (95% CI 0.83 to 0.87) at 10 years after initiation of ART. Children with adherence less than 80% had lowest survival in the first year (0.54, 95% CI 0.46 to 0.61). It reduced drastically at 5 and 10 years. After adjusting for demographic and clinical parameters, mortality was associated with poor adherence (<80%) (HR 11.70, 95% CI 8.82 to 15.53; p<0.001). However, CD4 counts of greater than 200 and age more than 1 year were protective.ConclusionsPoor adherence to ART and low CD4 counts were significantly associated with higher mortality. Adherence counselling should be an important component of CLHA monitoring in all ART centres. It is also important to identify children early in the infection and start ART medications appropriately.

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Effect of AIDS-defining events at initiation of antiretroviral therapy on long-term mortality of HIV/AIDS patients in Southwestern China: a retrospective cohort study

Cited by 6 publications

References 42 publications

HIV drug resistance and HIV transmission risk factors among newly diagnosed individuals in Southwest China

HIV drug resistance and HIV transmission risk factors among newly diagnosed individuals in Southwest China

The association between serum CD4 T lymphocyte counts and surgical outcomes in HIV/AIDS patients in Guangxi, China: a retrospective cohort study

Retrospective cohort analysis of survival of children living with HIV/AIDS in Mumbai, India

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