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The National Free Antiretroviral Treatment Program reduced mortality among adult patients in China with AIDS to rates similar to those of other low- or middle-income countries. A cumulative immunologic treatment failure rate of 50% after 5 years, due to the limited availability of second-line regimens, is of great concern.

Summary Background Hepatitis-related liver diseases are a leading cause of mortality and morbidity among people with HIV/AIDS taking combination antiretroviral therapy. We assessed the effect of hepatitis B virus (HBV) and hepatitis C virus (HCV) co-infection on HIV outcomes in patients in China. Methods We did a nationwide retrospective observational cohort study with data from the China National Free Antiretroviral Treatment Program from 2010–11. Patients older than 18 years starting standard antiretroviral therapy for HIV who had tested positive for HBV and HCV were followed up to Dec 31, 2012. We used Kaplan-Meier analysis and Cox proportional hazard models to evaluate survival, and logistic regression models to estimate virological failure, immunological response, and retention in care. Findings 33 861 patients with HIV met eligibility criteria. 2958 (8·7%) participants had HBV co-infection, 6149 (18·2%) had HCV co-infection, and 1114 (3·3%) had triple infection. All-cause mortality was higher in participants with triple infection (adjusted hazard ratio 1·90, 95% CI 1·53–2·37) and HCV co-infection (1·46, 1·25–1·70) than in those with HIV only, but not in those with HBV co-infection (1·06, 0·89–1·26). People with triple infection were also more likely to have virological failure (adjusted odds ratio [OR] 1·26, 95% CI 1·02–1·56) than were those with HIV only, whereas the difference was not significant for those with HBV co-infection (0·93, 0·80–1·10) or HCV co-infection (1·10, 0·97–1·26). No co-infection was significantly associated with a difference in CD4 cell count after 1 year of treatment. Loss to follow-up was more common among participants with triple infection (OR 1·37, 95% CI 1·16–1·62) and HCV co-infection (1·30, 1·17–1·45), but not HBV co-infection (0·93, 0·82–1·05), than among those with HIV only. Interpretation Screening for viral hepatitis is important in individuals diagnosed as HIV positive. Effective management for viral hepatitis should be integrated into HIV treatment programmes. Long-term data are needed about the effect of hepatitis co-infection on HIV disease progression. Funding The National Center for AIDS/STD Control and Prevention, China Center for Disease Control and Prevention.

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Background In China, many former plasma donors (FPD) were infected with the human immunodeficiency virus (HIV) in the early-mid 1990s. Highly active antiretroviral therapy (HAART) was provided to FPDs beginning in 2002. The effect of HAART on mortality in this cohort has never been described. Methods Retrospective analysis of the national HIV epidemiology and treatment databases, from 1993–2006. All HIV-infected subjects from ten high HIV prevalence counties in six provinces were eligible. Inclusion criteria were: 1) plasma donation history, 2) Western blot positive, 3) clinical diagnosis of AIDS or CD4+ cell count <200/μl at any time, and 4) age ≥18 at AIDS diagnosis. Results Of 9059 eligible subjects, 4093 met the inclusion criteria. Mean age was 41 years, 51% were male, 99% were farmers, and 87% were from Henan Province. Overall mortality declined from 27.3/100 person-years in 2001 to 4.6/100 person-years in 2006. Conversely, the proportion of AIDS patient-years on HAART increased from 0% in 2001 to 70.5% in 2006. In a multivariate Cox proportional hazards analysis, the greatest risk factor for mortality was not receiving HAART, with a hazard ratio 2.8, 95% confidence interval 2.4–3.3. Among treated patients, those initiating therapy with lower CD4+ cell counts and higher numbers of opportunistic infections were at greater risk of death. Conclusions The national treatment program has significantly reduced the mortality rate among HIV-infected FPDs through the use of generic drugs in a rural treatment setting with limited laboratory monitoring. Treatment success can be improved through increased coverage and earlier initiation of therapy.