title: Decreasing excess mortality of HIV-infected patients initiating antiretroviral therapy: comparison with mortality in general population in China, 2003-2009.
abstract: OBJECTIVE
  To evaluate excess mortality across calendar time comparing HIV-infected patients receiving combination antiretroviral therapy (cART) with the general Chinese population.
  
  
  METHODS
  Patients receiving free cART through the National Free Antiretroviral Therapy Program (NFATP) between January 1, 2003, and December 31, 2009, were included. Observed mortality rates, excess mortality rates, and standardized mortality ratios were calculated by calendar periods. Factors associated with excess mortality across calendar time were evaluated in multivariable Poisson regression models.
  
  
  RESULTS
  Among 64,836 HIV-infected patients, the observed and excess mortality rates in 2003-2004 were 9.5 deaths per 100 person-years [95% confidence interval (CI): 8.8 to 10.2] and 9.1 (95% CI: 8.5 to 9.8); in 2008-2009, these decreased to 5.6 (95% CI: 5.4 to 5.8) and 5.2 (95% CI: 5.0 to 5.4), respectively. The adjusted excess hazard ratio (eHR) for 2003-2004 in comparison to 2008-2009 was 1.27 (95% CI: 1.11 to 1.45). Patients initiating cART at CD4 cell counts <50 cells per microliter in comparison with ≥350 cells per microliter had an adjusted eHR of 9.92 (95% CI: 8.59 to 11.44). Patients starting cART at older ages also had greater excess mortality with an eHR of 1.63 (95% CI: 1.47 to 1.82) comparing ages ≥45 to 18-29 years. Standardized mortality ratio results were consistent with those for excess mortality.
  
  
  CONCLUSIONS
  Substantial decreases in excess mortality were observed from 2003 to 2009 in China among HIV-infected patients receiving free cART. However, mortality among HIV-infected patients remained higher than the general Chinese population. As more efficacious first- and second-line cART regimens become increasingly available to Chinese HIV-infected patients, further reductions in overall and excess mortality are likely.
authors.affiliation: *Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC; †Division of Treatment and Care, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China; ‡Division of Infectious Diseases, School of Medicine, University of North Carolina, Chapel Hill, NC; and §Division of Infectious Diseases, Beijing Ditan Hospital Capital Medical University, Beijing, China.
authors.forename: Hao
authors.initials: H
authors.lastname: Zhu
authors.forename: Sonia
authors.initials: S
authors.lastname: Napravnik
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Eron
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Cole
authors.forename: Ye
authors.initials: Y
authors.lastname: Ma
authors.forename: David A
authors.initials: DA
authors.lastname: Wohl
authors.forename: Zhihui
authors.initials: Z
authors.lastname: Dou
authors.forename: Yao
authors.initials: Y
authors.lastname: Zhang
authors.forename: Zhongfu
authors.initials: Z
authors.lastname: Liu
authors.forename: Decai
authors.initials: D
authors.lastname: Zhao
authors.forename: Lan
authors.initials: L
authors.lastname: Yu
authors.forename: Xia
authors.initials: X
authors.lastname: Liu
authors.forename: Myron S
authors.initials: MS
authors.lastname: Cohen
authors.forename: Fujie
authors.initials: F
authors.lastname: Zhang
mesh_terms: D000293:Adolescent; D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D002681:China; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends*; D016019:Survival Analysis; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents