Excess mortality and associated factors among people living with HIV initiating highly active antiretroviral therapy in Luzhou, China 2006–2020

Abstract

Background To estimate crude mortality, excess mortality, and standardized mortality rates (SMR) among people living with HIV (PLHIV) initiating highly active antiretroviral therapy (HAART) in Luzhou, China 2006–2020, and assess associated factors. Methods PLHIV initiating HAART in the HIV/AIDS Comprehensive Response Information Management System (CRIMS) in Luzhou, China 2006–2020 were included in the retrospective cohort study. The crude mortality, excess mortality, and SMR were estimated. Multivariable Poisson regression model was used for analyzing risk factors associated with excess mortality rates. Results The median age among 11,468 PLHIV initiating HAART was 54.5 years (IQR:43.1–65.2). The excess mortality rate decreased from 1.8 deaths/100 person-years (95% confidence interval [CI]:1.4–2.4) in 2006–2011 to 0.8 deaths/100 person-years (95%CI:0.7–0.9) in 2016–2020. SMR decreased from 5.4 deaths/100 person-years (95%CI:4.3–6.8) to 1.7 deaths/100 person-years (95%CI:1.5–1.8). Males had greater excess mortality with the eHR of 1.6 (95%CI:1.2–2.1) than females. PLHIV with CD4 counts ≥ 500 cells/μL had the eHR of 0.3 (95%CI:0.2–0.5) in comparison to those with CD4 counts < 200 cells/μL. PLHIV with WHO clinical stages III/IV had greater excess mortality with the eHR of 1.4 (95%CI:1.1–1.8). PLHIV with time from diagnosis to HAART initiation ≤ 3 months had the eHR of 0.7 (95%CI:0.5–0.9) compared to those with time ≥ 12 months. PLHIV with initial HAART regimens unchanged and viral suppression had the eHR of 1.9 (95%CI:1.4–2.6) and 0.1 (95%CI:0.0–0.1), respectively. Conclusions The excess mortality and SMR among PLHIV initiating HAART in Luzhou, China decreased substantially from 2006 to 2020, but the mortality rate among PLHIV was still higher than general population. PLHIV who were male, with baseline CD4 counts less than 200 cells/μL, WHO clinical stages III/IV, time from diagnosis to HAART initiation ≥ 12 months, initial HAART regimens unchanged, and virological failure had a greater risk of excess deaths. Early and efficient HAART would be significant in reducing excess mortality among PLHIV.

Survival analysis of PLWHA undergoing combined antiretroviral therapy: exploring long-term prognosis and influencing factors

“…The results of the survival analysis demonstrated that the greatest number of deaths occurred within the first year of ART initiation, with 29.49% (146/495) of the total mortality attributed to AIDS-related illnesses. These findings are consistent with previous studies ( 9–11 , 13 , 14 ), emphasizing the critical and high-risk nature of the initial treatment year and the importance of enhanced follow-up and monitoring for newly treated patients, improved treatment adherence, and support for immune system reconstruction. The cumulative survival rates for patients at 1, 5, 10, and 15 years after ART initiation were 0.97, 0.90, 0.85, and 0.79 ( Table 2 ), respectively.…”

“…Heterosexual transmission was identified as the predominant mode of HIV infection in this region, accounting for 93.97% of all transmission routes, whereas homosexual transmission only accounted for 2.61%, which is consistent with the findings from similar studies conducted in southwestern China, such as Liangshan, Sichuan Province (9), and Luzhou, Sichuan Province (13). However, in the eastern regions of China, including Nanjing City (10), Beijing City (11), and Tianjin City ( 14), the proportion of homosexual transmission exceeds that of heterosexual transmission.…”

Factors Associated with Late Diagnosis of Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) in a University Hospital in Brazil: Challenges to Achieving the 2030 Target

“…A retrospective cohort study conducted in China between 2006 and 2020 demonstrated that the early initiation of ART in people living with HIV significantly reduced the mortality rate in this population, directly impacting overall mortality rates. However, the same study found that factors such as being male, having a very late HIV diagnosis, initiating ART after 12 months of diagnosis, and virologic failure (detectable viral load after 6 months of treatment initiation or modification) led to a higher mortality rate [ 29 , 33 ].…”

The iron group transition-metal (Fe, Ru, Os) coordination of Se-doped graphitic carbon (Se@g-C3N4) nanostructures for the smart therapeutic delivery of zidovudine (ZVD) as an antiretroviral drug: a theoretical calculation perspective

“…In a study by Ayub et al, carbon nanocone oxide (ONC) is used as a drug carrier for zidovudine (ZVD) since they are efficient in delivering to the target site while reducing toxicity and generic accumulation, which are oen related with intravenous traditional methods. 23,25 Another promising avenue involves the use of nanoparticles, which offer precise drug targeting and reduce the need for frequent dosages. Nanoparticles encapsulate the drugs and deliver them directly to the specic target site within the body due to their diminutive size and polymeric composition.…”