Five-year outcomes of the China National Free Antiretroviral Treatment Program.
BACKGROUND
China's National Free Antiretroviral Treatment Program began in 2002 and, by August 2008, included more than 52 000 patients.


OBJECTIVE
To report 5-year outcomes on adult mortality and immunologic treatment failure rates and risk factors.


METHODS
Open cohort analysis of a prospectively collected, observational database.


METHODS
China.


METHODS
All patients in the national treatment database from June 2002 to August 2008. Patients were excluded if they had not started triple therapy or had missing treatment regimen information.


METHODS
Antiretroviral therapy according to Chinese national treatment guidelines.


METHODS
Mortality rate and immunologic treatment failure rate, according to World Health Organization criteria.


RESULTS
Of 52 191 patients, 48 785 were included. Median age was 38 years, 58% were men, 53% were infected through plasma or blood, and the median baseline CD4 cell count was 0.118x10(9) cells/L. Mortality was greatest during the first 3 months of treatment (22.6 deaths per 100 person-years) but decreased to a steady rate of 4 to 5 deaths per 100 person-years after 6 months and maintained this rate over the subsequent 4.5 years. The strongest mortality risk factors were a baseline CD4 cell count less than 0.050x10(9) cells/L (adjusted hazard ratio [HR] compared with a count>or=0.200x10(9) cells/L, 3.3 [95% CI, 2.9 to 3.8]) and having 4 to 5 baseline symptom categories (adjusted HR compared with no baseline symptom categories, 3.4 [CI, 2.9 to 4.0]). Treatment failure was determined among 31 070 patients with 1 or more follow-up CD4 cell counts. Overall, treatment failed for 25% of patients (12.0 treatment failures per 100 person-years), with the cumulative treatment failure rate increasing to 50% at 5 years.


CONCLUSIONS
Immunologic treatment failure does not necessarily correlate well with virologic treatment failure.


CONCLUSIONS
The National Free Antiretroviral Treatment Program reduced mortality among adult patients in China with AIDS to rates similar to those of other low- or middle-income countries. A cumulative immunologic treatment failure rate of 50% after 5 years, due to the limited availability of second-line regimens, is of great concern.
Zhang
Fujie
F
National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China. treatment@chinaaids.cn
Dou
Zhihui
Z
Ma
Ye
Y
Zhao
Yan
Y
Liu
Zhongfu
Z
Bulterys
Marc
M
Chen
Ray Y
RY
D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D002681:China / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009313:National Health Programs; D015397:Program Evaluation; D011446:Prospective Studies; D013223:Statistics as Topic; D016019:Survival Analysis; D016896:Treatment Outcome