Determinants of Progression to AIDS and Death Following HIV Diagnosis: A Retrospective Cohort Study in Wuhan, China

Abstract

ObjectiveTo identify determinants associated with disease progression and death following human immunodeficiency virus (HIV) diagnosis.MethodsDisease progression data from the diagnosis of HIV infection or acquiring immunodeficiency syndrome (AIDS) to February 29, 2012 were retrospectively collected from the national surveillance system databases and the national treatment database in Wuhan, China. Kaplan-Meier method, Logistic regression and Cox proportional hazards model were applied to identify the related factors of progression to AIDS or death following HIV diagnosis.ResultsBy the end of February 2012, 181 of 691 HIV infectors developed to AIDS, and 129 of 470 AIDS patients died among whom 289 cases received concurrent HIV/AIDS diagnosis. Compared with men infected through homosexual behavior, injection drug users possessed sharply decreased hazard ratio (HR) for progression to AIDS following HIV diagnosis [HR = 0.31, 95% confidence interval (CI), 0.18–0.54, P = 4.01×10−5]. HIV infectors at least 60 years presented 1.15-fold (HR = 2.15, 95% CI, 1.15–4.03, P = 0.017) increased risk to develop AIDS when compared with those aged 17–29 years. Similarly, AIDS patients with diagnosis ages between 50 and 59 years were at a 1.60-fold higher risk of death (HR = 2.60, 95% CI, 1.18–5.72, P = 0.017) compared to those aged 19–29 years. AIDS patients with more CD4+ T-cells within 6 months at diagnosis (cell/µL) presented lower risk of death (HR = 0.29 for 50- vs <50, 95% CI, 0.15–0.59, P = 0.001). The highly active antiretroviral therapy (HAART) delayed progression to AIDS from HIV diagnosis (HR = 0.15, 95% CI, 0.07–0.34, P = 6.46×10−6) and reduced the risk of death after AIDS diagnosis (HR = 0.02, 95% CI, 0.01–0.04, P = 7.25×10−25).ConclusionsProgression to AIDS and death following HIV diagnosis differed in age at diagnosis, transmission categories, CD4+ T-cell counts and HAART. Effective interventions should target those at higher risk for morbidity or mortality, ensuring early diagnosis and timely treatment to slow down the disease progression.

Rates and risk factors associated with the progression of HIV to AIDS among HIV patients from Zhejiang, China between 2008 and 2012

“…The rate at which HIV progressed to AIDS decreased from 33.9 % in 2008 to 25.9 % in 2012. These rates were greater than those observed in developed countries, such as British Columbia (7 % in 2013), Brazil (6.2 % between 2000 and 2008), but they were similar to the rates in Africa and Asia countries [ 12 – 16 ]. In this study, AIDS was diagnosed within 1 year of HIV diagnosis, which is similar to the diagnostic process in developed countries.…”

Factors associated with 36-month loss to follow-up and mortality outcomes among HIV-infected adults on antiretroviral therapy in Central Kenya

“…On the other hand, older patients tend to have a higher risk of mortality [31]. A study in China reported that HIV patients with diagnosis at ages between 50 and 59 years were at a 1.60-fold higher risk of death compared to those aged 19-29 years [32]. Older patients are likely to have disease progression despite ART due to a weaker immune system that accompanies old age and more comorbidities.…”

Modelling immune deterioration, immune recovery and state-specific duration of HIV-infected women with viral load adjustment: using parametric multistate model

“…Patients with higher educational levels had significantly reduced rates of immune deterioration. Other researchers [53,54] also found that higher education promotes a better rate of change of immune recovery, possibly due to better knowledge about their treatment and disease, access to health services, or functional status. We have also observed that patients having higher educational levels were significantly associated with longer time spent in normal disease states.…”