title: Long-Term Effectiveness of Antiretroviral Therapy in China: An Observational Cohort Study from 2003-2014.
abstract: In order to assess the effectiveness of the Chinese government's expanded access program, a cohort study on all adult HIV patients in Shenzhen was conducted from December 2003 to February 2014 to estimate the effects of antiretroviral therapy (ART) on mortality, tuberculosis and CD4 cell counts. Marginal structural regression models adjusted for baseline and time-varying covariates. Of the 6897 patients enrolled and followed up for a maximum of 178 months, 44.92% received ART. Among patients who commenced receiving ART during the study, there were 98 deaths and 59 new tuberculosis diagnoses, while there were 410 deaths and 201 new tuberculosis diagnoses among those without ART. ART was associated with both lower mortality (hazard ratio [HR] = 0.18; 95% confidence interval [CI] = 0.11-0.27) and the presence of tuberculosis (HR = 0.27; 95% CI = 0.19-0.37). Each month of ART was associated with an average increase in CD4 cell count of 6.52 cells/µL (95% CI = 6.08-7.12 cells/µL). In conclusions, the effectiveness of ART provided by China government health services is the same as that in higher-income countries. Accounting to higher mortality rates from the delay of starting ART, faster expansion and timely imitation of ART are urgent.
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing 211166, China. hp19880310@163.com.
authors.forename: Peng
authors.initials: P
authors.lastname: Huang
authors.affiliation: Shenzhen Center for Disease Control and Prevention, Shenzhen 518055, China. tangjingguang2014@126.com.
authors.forename: Jingguang
authors.initials: J
authors.lastname: Tan
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing 211166, China. mawenzhe7@njmu.edu.cn.
authors.forename: Wenzhe
authors.initials: W
authors.lastname: Ma
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing 211166, China. zhenghui8946@hotmail.com.
authors.forename: Hui
authors.initials: H
authors.lastname: Zheng
authors.affiliation: Shenzhen Center for Disease Control and Prevention, Shenzhen 518055, China. luyan_sz@126.com.
authors.forename: Yan
authors.initials: Y
authors.lastname: Lu
authors.affiliation: National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China. wangning_12@126.com.
authors.forename: Ning
authors.initials: N
authors.lastname: Wang
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing 211166, China. zhihangpeng@njmu.edu.cn.
authors.forename: Zhihang
authors.initials: Z
authors.lastname: Peng
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing 211166, China. rongbinyu@njmu.edu.cn.
authors.forename: Rongbin
authors.initials: R
authors.lastname: Yu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D023241:Antiretroviral Therapy, Highly Active; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D002681:China / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000401:mortality; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D014376:Tuberculosis / Q000453:epidemiology; D055815:Young Adult
chemical_list: D018501:Antirheumatic Agents
keywords: ART; China; HIV; mortality; observational cohort study