Immediate antiretroviral therapy decreases mortality among patients with high CD4 counts in China: a nationwide, retrospective cohort study

Abstract

Background

Clinical trials have demonstrated that immediate initiation of antiretroviral therapy (ART) reduces AIDS-related morbidity and mortality. We tested the hypothesis that initiating ART ≤30 days after HIV diagnosis would be associated with reduced mortality among people living with HIV (PLWH) with CD4 counts >500 cells/mm³.

Methods

PLWH enrolled in the Chinese National Free ART Program between January 2012 and June 2014 were evaluated. The cohort was restricted to PLWH with CD4 counts >500 cells/mm³. Participants were followed for 12 months. Cox proportional hazards model was used to determine hazard ratios (HRs) for PLWH who initiated ART after HIV diagnosis. ART initiation was treated as a time-dependent variable.

Results

We enrolled 34,581 PLWH with CD4>500 cells/mm³. 1,838 (5.3%) initiated ART ≤30 days after HIV diagnosis (Immediate ART Group), and 19 deaths were observed with a mortality rate of 1.04 per 100 PY. A total of 58 deaths were documented among the 5,640 PLWH in the Delayed ART Group with a mortality rate of 2.25 per 100 PY. There were 713 deaths among the 27,103 PLWH in the No ART Group with a mortality rate of 2.39 per 100 PY. After controlling for potential confounding factors, ART initiation at ≤30 days (adjusted HR=0.37, CI=0.23–0.58) was a statistically significant protective factor.

Conclusions

We found that immediate ART is associated with a 63% reduction in overall mortality among PLWH with CD4 cell counts >500 cells/mm³ in China. These results support the recommendation to initiate ART immediately following HIV diagnosis.