Effect of individualized management on ART failure among HIV/AIDS patients: a follow-up study in Yili prefecture, Xinjiang Uygur Auto-nomous Region

Objective To analyze the effect of individualized management on antiretroviral therapy (ART) failure among human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) patients for developing effective individualized management scheme for HIV/AIDS patients on ART.

Methods A total of 1 882 HIV/AIDS patients (≥ 16 years old) on ART and with baseline CD4⁺T lymphocytes (CD4⁺T) counts were recruited in the Second People′s Hospital of Yining City, Xinjiang Uygur Autonomous Region (Xinjiang) from 2018 through October 2020. Then the patients were randomly assigned into two gender- and age-matched groups (941 in each group): a group with ordinary management including routine follow-up interview and CD4⁺T count, free ART, psychological support, and health education and the other group with increased face-to-face follow-ups for comprehensive assessment on conditions relevant to ART by medical staff or community workers and the development of individualized management schemes. Mann-Whitney test was used to analyze the trend in CD4⁺T count change of the two groups over time; the cumulative incidence curve of ART failure of the two groups were plotted with Kaplan-Meier (K-M) method and Cox proportional hazard regression model was adopted to explore influencing factors of ART failure.

Results Compared with those in the routine management group, significantly higher CD4⁺T counts were detected in follow-up laboratory tests in the individualized management group (P < 0.05 for all), especially for the patients with the baseline CD4⁺T count of < 350/μL after 6-month ART. The K-M analysis showed that at the end of follow-up, the cumulative ART failure rate (11.4%, 107/941) of the individualized management group was significantly lower than that (16.9%, 159/941) of the routine intervention group (P = 0.001 in Log-rank test). Multivariate Cox regression analysis revealed that the patients under individualized management (hazard risk HR = 0.733, 95% confidence interval 95%CI: 0.572-0.939) and those with the CD4⁺T count of ≥ 350/μL at the first follow-up (HR = 0.271, 95%CI: 0.212 – 0.346) were at lower ART failure risk; but the patients with the interval of ≥ 366 days between the HIV infection confirmation and the beginning of ART were at a higher risk of ART failure (HR = 1.474, 95%CI: 1.059 – 2.050).

Conclusion Individualized management could reduce immunological failure among HIV/AIDS patients on ART; low CD4⁺T count and long interval between HIV infection confirmation and the beginning of ART are risk factors for ART failure for the patients on the treatment.