Suboptimal immune recovery and associated factors among people living with HIV/AIDS on second‐line antiretroviral therapy in central China: A retrospective cohort study

Abstract

The introduction and scale-up of antiretroviral therapy (ART) have contributed to significantly improved patients with acquired immune deficiency syndrome (AIDS) quality of life and prolongs their survival. This has occurred by suppressing viral replication and recovering the CD4 cell count. However, some patients do not normalize their CD4 cell count, despite suppression of the viral load (VL). Patients with suboptimal immune recovery (SIR), as defined by a VL < 400 copies/ml with a CD4 cell count of<200 cells/μl, after ART initiation, exhibit severe immune dysfunction and have a higher risk of AIDS and non-AIDS events. In recent years, People living with HIV/AIDS (PLWHA) with first-line ART failure began to gradually switch to secondline ART. This study aimed to examine the prevalence and factors affecting SIR among PLWHA who switch to second-line ART in rural China. A 1-year retrospective cohort study was conducted among PLWHA who switched to second-line ART between January 2009 and December 2018. All patients with a VL < 400 copies/ml after 1 year of second-line ART were included. SIR was defined as a CD4 cell count <200 cells/μl and a VL < 400 copies/ml after 1 year of second-line ART. The data collected from medical records were analyzed by univariate and multivariate analyses. A total of 5294 PLWHA met the inclusion criteria, 24 died, and 1152 were lost to follow-up after 1 year of second-line ART. Among 4118 PLWHA who were followed up, 3039 with a VL < 400 copies/ml had their data analyzed, and the prevalence of SIR was 13.1%. The patients' mean age at recruitment was 47.6 ± 8.1 years and 45.3% were men. A total of 30.7% of patients were HIV-positive for >8 years and 88.2% were receiving ART before starting second-line ART for >3 years. The mean CD4 cell count was 354.8 ± 238.2 cells/μl. A multivariable analysis showed that male sex, single status (unmarried or divorced), and a low CD4 cell count were risk factors for SIR among PLWHA with second-line ART. The prevalence of SIR among PLWHA who switched to second-line ART in this retrospective cohort study is lower than that in most other

Mortality Risk Factors among People Living with HIV Receiving Second-line Antiretroviral Therapy in Rural China

“…Here, we find that single/window individuals are a risk factor for failure in second-line ART, which is consistent with some research findings. For example, A multivariable analysis showed that single status (unmarried or divorced) was a risk factors for PLHIV with second-line ART [25]. Older age was a higher risk of death, we report that the HR of death among PLHIV older than 50 years was 2.56 times that of those under 40, patients with 40-50 years old was not show higher HR of death compared with those under 40.…”

Analysis on epidemiological characters and HIV care continuum of HIV-infected students: a retrospective cohort study in Shandong province, China

“…Furthermore, ART can reduce viral load of HIV-infected individuals and therefore reduce sexual transmission [28][29][30]. The updated Chinese guidelines for diagnosis and treatment of HIV/AIDS (2018) recommend early initiation of ART for HIV prevention.Zhu XY et al [31] conducted a study on the timeliness of ART for HIV infected individuals in Shandong Province, which showed that young people aged 15-24 were less likely to accept ART timely. However, there has not study to nd the reasons of HIV-infected students delaying in accepting HIV care continuum up to now.This study analyzed the epidemiological characters and HIV care status of HIV-infected students in Shandong province during 2017 to 2019, and explored the in uencing factors of student cases accepting CD4 test and ART during 30 days after diagnosis.…”

“…Zhu XY et al [31] conducted a study on the timeliness of ART for HIV infected individuals in Shandong Province, which showed that young people aged 15-24 were less likely to accept ART timely. However, there has not study to nd the reasons of HIV-infected students delaying in accepting HIV care continuum up to now.…”