Factors Associated with the Effectiveness of National Free Antiretroviral Treatment Program in HIV Infected Patients of Yi Nationality from Southwest China: Evidence from A Cohort Study to Provide Clues for Improvement

Abstract

Background: Despite the current achievements of HIV management in the source-limited region of Liangshan Autonomous Prefecture, a small population remains with unsatisfactory virologic outcomes and suboptimal immune recovery. This cohort study aimed to identify potential risk factors of suboptimal clinical outcomes and to provide clues for improvement in people living with HIV (PLWH) from China’s National Free Antiretroviral Treatment Program (NFATP) in Zhaojue County, Liangshan Autonomous Prefecture of Yi nationality. Results: A total of 608 HIV infected adult patients in NFATP at the median age of 35(31, 40) were enrolled for analysis. During the 2.15(1.54, 4.00)-year follow-up, 502 (82.6%) patients achieved the viral load of <1000 copies/mL after over 6 months of antiretroviral therapy(ART). Among them, 398 (65.5%) cases achieved complete viral suppression with viral load <50 copies/mL while 104 (17.1%) cases remained with low level viremia (LLV, 50≤ viral load ≤1000 copies/mL). Patients with longer infection duration (OR =1.017 [95%CI: 1.002-1.033], p = 0.026), male gender (OR =1.632 [95%CI: 1.053-2.53], p = 0.028), positive hepatitis C virus antibody (OR =1.687 [95%CI: 1.093-2.604], p = 0.018) or infection through injecting drug use (IDU) (OR =1.584 [95%CI: 1.022-2.455], p = 0.04) were more likely to experience the undesirable outcome of LLV. Moreover, 254 (63.8%) of 398 patients with viral suppression achieved optimal immune recovery with the CD4 count ≥ 350 cells/μL. Patients with lower body mass index (BMI) (21.00±2.94 Kg/m 2 , OR=0.921 [95%CI: 0.854-0.994], p = 0.034) and higher fasting blood glucose (4.99±1.01 mmol/L, OR=1.343 [95%CI: 1.087-1.658], p = 0.006) were less likely to achieve the CD4 count ≥ 350 cells/μL after viral suppression. Conclusions: In this long-term cohort study of PLWH from Zhaojue County, Liangshan, most patients achieved virologic success on ART provided by NFATP but optimal immune recovery was yet to be expected. Approaches including strict control of illegal drug deal, patient education, and nutritional status management could be conducive to better prognosis for this population.