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

Abstract

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.

Clinical outcomes of people living with human immunodeficiency virus (HIV) with diffuse large B-cell lymphoma (DLBCL) in Shanghai, China

“…In addition to the above issues, Chinese HIV patients are somewhat unique in that the diagnosis of HIV infection is often late, [ 10 , 11 ] and many patients receive an HIV diagnosis after the diagnosis of lymphoma. [ 12 ] Considering previously published data, a low CD4 cell count and poorly controlled HIV replication lead to a poor prognosis of DLBCL in general for these patients.…”

Immediate antiviral therapy for HIV-infected persons faces with various obstacles

“…E-mail: luhongzhou@fudan.edu.cn refusal of treatment, negative psychological emotions, treatment related costs, etc. (24)(25)(26). ii) Supply-side.…”

Effect of a multi-dimensional case management model on anti-retroviral therapy-related outcomes among people living with human immunodeficiency virus in Beijing, China

“…Initially, this program provided free ART mainly focus on PLWH whom had CD4 cell counts less than 200/μl in 2004, however, this changed to less than 350/μl in 2008 and less than 500/μl in 2014. Patients with higher CD4 cell counts were treated with ART when they made a special request to the providers [ 6 ]. However, currently, because of the undisputed benefits of ART, international guidelines recommend antiretroviral therapy for all patients with HIV infection regardless of CD4 cell count, and therefore our center has adaopted these guidelines [ 7 – 10 ].…”