Survival of HIV/AIDS patients receiving highly antiretroviral therapy in Nanjing city, 2004 – 2016

  Objective  To examine the survival status of human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) patients initially receiving highly antiretroviral therapy (HAART) and to explore associated factors with HIV-related death in Nanjing city during 2004 – 2016.

  Method  A retrospective cohort study was conducted to analyze the data on HIV/AIDS patients over 15 years old initially receiving HAART in Nanjing city during 2004 – 2016. Life table method was adopted to estimate survival rates and the Cox proportion hazard model was used to analyze predictors of HIV-related death.

  Results  Among the 2 523 participants, the median age when starting HAART was 32 years (interquartile range IQR: 26 – 44) and the median time from the diagnosis of HIV positive to the beginning of HAART was two months (IQR: 1 – 8 months). OF the participants, 93.26% were males; 85.93% were locally registered residents; and 50.65% were unmarried. The body mass index (BMI) ranged from 18.5 to 23.9 kg/m² among 63.69% of the participants. HIV infection via homosexual transmission was ascertained for 73.17% of the participants. The baseline mean of CD4⁺T cell count was 271 cells/μL for all the participants. The initial therapeutic regimen was tenofovir plus lamivudine plus efavirenz or nevirapine (TDF+3TC+EFV/NVP) for 50.81% of the participants and 47.9% of the participants were at the first clinical stage based on World Health Organization (WHO) category when receiving the initial treatment. During the follow-up period, a total of 70 cases died of HIV-related diseases and the mortality was 1.49/100 (85.96/5 777.69) person years. The cumulative survival rate of the participants was 98.01%, 96.93%, 95.20%, 94.30%, and 92.76% after 1, 2, 5, 7, and 12 years of HAART, respectively. Multivariate Cox proportion hazard models revealed that the participants with following characteristics were at higher mortality risk: aged ≥ 50 years (hazard risk HR = 11.31, 95% confidence interval 95% CI: 2.62 – 48.87), with 4 or more signs/symptoms of AIDS at the baseline examination (HR = 2.98, 95% CI: 1.37 – 6.50); whereas the participants being infected via homosexual transmission (HR = 0.29, 95% CI: 0.10 – 0.87), with the body mass index (BMI) of ≥ 24 kg/m² (HR = 0.06, 95% CI: 0.01 – 0.27), and with CD4⁺T cell count of ≥ 350 cells/μL at the baseline examination (HR = 0.23, 95% CI: 0.07 – 0.76) were at lower mortality risk.

  Conclusion  The cumulative survival rate is higher among HAART-treated HIV/AIDS patients in Nanjing city but the patients over 50 years old, with signs/symptoms of AIDS, lower BMI, and lower CD4⁺T cell count are at a higher mortality risk.