Determinants of antiretroviral therapy initiation and treatment outcomes for people living with HIV in Vietnam.
OBJECTIVE
This study explores patient characteristics that are significantly associated with very late combination antiretroviral therapy (cART) initiation (CD4 count ≤100 cells/mm³) and examines the association between patient characteristics and treatment outcomes, CD4 recovery, and mortality.


METHODS
Data were obtained from the clinical records of 2,198 HIV/AIDS patients in 13 outpatient clinics across 6 provinces in Vietnam.


METHODS
Multivariate logistic regression and Cox proportional hazards regression were used to identify patient characteristics that are significantly associated with very late cART initiation and to measure relationships between patient characteristics and treatment outcomes.


RESULTS
Very late cART initiation was significantly associated with being male compared with female (odds ratio [OR], 0.36; 95% CI, 0.23-0.58), becoming HIV infected through injecting drugs (OR, 2.13; 95% CI, 1.09-4.14), and having opportunistic infections at cART initiation (OR, 1.69; 95% CI, 1.02-2.86). Being male (female vs male: hazard ratio [HR], 0.45; 95% CI, 0.20-0.98), very late cART initiation (timely vs late: HR, 0.18; 95% CI, 0.04-0.72), low baseline body mass index (BMI) (HR, 0.95; 95% CI, 0.92-0.98), and later baseline WHO clinical stage (WHO clinical stage IV vs combined group of stage I and II: HR, 5.70; 95% CI, 3.90-7.80) were significantly associated with death, whereas being female compared with male (HR, 1.51; 95% CI, 1.14-1.99) and timely cART initiation (HR, 35.45; 95% CI, 13.67-91.91) were significant predictors of CD4 recovery.


CONCLUSIONS
Timely testing of patients for HIV, increasing use of CD4 count testing services, and starting cART earlier are essential to reduce mortality and improve treatment outcomes.
National Drug Alcohol Research Centre, The University of New South Wales, Sydney, Australia Kirby Institute, Sydney, Australia. d.tran@unsw@edu.au
Dam Anh
DA
Tran
Anthony
A
Shakeshaft
Anh Duc
AD
Ngo
Kylie-Ann
KA
Mallitt
David
D
Wilson
Christopher
C
Doran
Lei
L
Zhang
D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy / Q000401:mortality / Q000821:virology; D000328:Adult; D044966:Anti-Retroviral Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D015992:Body Mass Index; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D003625:Data Collection; D018450:Disease Progression; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000401:mortality / Q000821:virology; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009894:Opportunistic Infections / Q000150:complications; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome; D014744:Vietnam / Q000453:epidemiology; D055815:Young Adult
D044966:Anti-Retroviral Agents