Improvement in survival among HIV-infected individuals in the Republic of Korea: Need for an early HIV diagnosis

Abstract

BackgroundThere is little information describing survival in HIV-infected patients after primary diagnosis in Korea, and changes in survival over time. This study investigated survival times, survival characteristics, and changes in survival after initial HIV diagnosis. Survival was characterized by evaluation of the immune status at primary HIV diagnosis nationwide.MethodsA total of 5,323 HIV-infected individuals were registered with the government and followed until the end of 2007. Survival following HIV diagnosis was estimated based on epidemiological characteristics. We examined 3,369 individuals with available initial CD4+ T-cell counts within 6 months of HIV diagnosis to estimate survival based on immune status at diagnosis. The association between epidemiological variables and survival times was analyzed with univariate and multivariate Cox's proportional hazards model.ResultsIndividuals died during the study period (n = 980), and 45% of the individuals died within 6 months of HIV diagnosis. The median survival following HIV diagnosis was 16.7 years. Survival were longer in women, in younger persons, in individuals diagnosed at blood centers, and in individuals diagnosed later in the study period. Survival were shortest in individuals with CD4+ T-cell counts <200 cells/mm3 at HIV diagnosis. These results suggest that early HIV diagnosis in Korea is imperative to increase survival and to promote the quality of life for HIV-infected individuals with governmental support.ConclusionThe median survival time of HIV-infected individuals following HIV diagnosis was 16.7 years in Korea. The survival was significantly lower in individuals with CD4+ T-cell counts <200 cells/mm3 at HIV diagnosis and higher by introduction of drugs and development of therapy.

Determination of Predictors Associated With HIV/AIDS Patients on ART Using Accelerated Failure Time Model for Interval Censored Survival Data

“…Most of the previous studies have suggested that age is a significant prognostic factor (Saah et al, 1994;Bachani et al, 2010;Ghate et al, 2011;May et al, 2010;Kee et al, 2009). A younger person undergoing ART is more likely to survive longer as compared to an older person, i.e., old age is associated with high risk of disease progression but in our analysis age is not found to be a significant prognostic factor.…”

“…Patients with CD4 cell <200 cells/mm 3 have 3.31 times more hazard to die than patient who had CD4 cell more than 200 cells/mm 3 . The mortality is inversely proportional to CD4 count, cumulative probability of AIDS and death increased substantially with decreasing CD4 cell count Ghate et al (2011;ATCC, 2009;May et al, 2007;Rai et al, 2013;Rajasekaran et al, 2009;Kee et al, 2009). It emphasizes the importance of creating awareness about early diagnosis so that the eligible patients can be initiated on ART earlier.…”

“…There are several studies which describes the estimation of survival of HIV populations and underlying covariates effect on hazard of death among HIV patients on ART by using Cox proportional hazard model for right censored data in India and resource limited setting countries (Ghate et al, 2011;Rai et al, 2013;Kee et al, 2009;Jerene et al, 2006). However, no one has tried to identify the significant predictor associated with the survival of HIV/AIDS patients undergoing ART using parametric AFT Model under interval censored set up.…”

Survival rate of AIDS disease and mortality in HIV-infected patients: a meta-analysis

“…This effective treatment increases survival following HIV infection from 10e12 years to 25 years. 4,5 Effective treatment with HAART can control replication of the virus within the body, and strengthen the immune system to regain the capacity to suppress infections. Accordingly, HIV/AIDS is now characterised as a chronic but manageable disease.…”

Late presentation of HIV disease and its associated factors among newly diagnosed patients before and after abolition of a government policy of mass mandatory screening

“…8,9 In addition, following the AIDS Prevention Act, the government has provided HIV-infected patients in Korea with free medical care since 1987, including highly active antiretroviral therapy (HAART), which was introduced in mid-1998. 10 Most previous studies of late presenters of HIV disease have been conducted in Western industrialized countries, 11e18 where mandatory screening for HIV has not been carried out. To our knowledge, few reports have focused on communities where HIV prevention policies of mass mandatory screening were in place for more than 10 years.…”