title: Rates and risk factors associated with the progression of HIV to AIDS among HIV patients from Zhejiang, China between 2008 and 2012.
abstract: OBJECTIVE
  The objective of this study was to determine the rate of acquired immune deficiency syndrome (AIDS) in Zhejiang province and to identify specific factors associated with progression of this disease.
  
  
  METHODS
  This study utilized a retrospective cohort to identify the specific factors involved in the progression of human immunodeficiency virus (HIV) to AIDS. We collected data of patients existing in care between 2008 and 2012 from the national surveillance system databases. We performed our analyses using a multivariate Cox proportional hazards model.
  
  
  RESULTS
  This study included 9216 HIV-positive patients (75.6 % male), which yielded 12,452 person-years (py) of follow-up-data. The AIDS progression rates were 33.9 % (2008), 33.6 % (2009), 38.1 % (2010), 30.6 % (2011) and 25.9 % (2012). We observed a significant reduction in the rate of progression Of HIV to AIDS post-2010 (Pearson χ(2) = 4341.9, P < 0.001). The cumulative AIDS progression incidence rates were 33.4, 35.4, 36.4, 37.0 and 37.04 per 100 py in 1 each of the 5 years of follow-up. This study found that age was an independent risk factor for the progression of HIV to AIDS. Compared with patients infected with HIV by homosexual transmission, patients infected with HIV by heterosexuals transmission or blood transfusion had a reduced hazard ratio (HR) for progression to AIDS (heterosexual transmission: HR = 0.695, 0.524, P = 0.007; blood transfusion: HR = 0.524, P = 0.015). Diagnosed with HIV from 2011 to 2012 and having a higher CD4+ cell count (350-500 cells/mm(3); or >500 cells/mm(3)) at baseline were independently associated with lower rates of HIV progression to AIDS [HR = 0.382, 0.380, 0.187, P < 0.001]. Patients with a CD+ T-cell count of 200-350 cells/mm(3) or greater than 350 cells/mm(3) were less likely to develop AIDS following HIV diagnosis than were those patients without HAART treatment.
  
  
  CONCLUSIONS
  This study found a high progression rate from HIV to AIDS in HIV patients residing within Zhejiang province from 2008 to 2010. This rate decreased after 2010, which coincided with the new criteria for HAART treatment, which likely contributed to the observed reduction in the rate of progression. Initiation of HAART with higher CD4+ T-cell count may reduce rate of AIDS progression. Based on our results, we conclude that efficient strategies for HIV screening, as well as early diagnosis and treatment are necessary to reduce the progression of HIV to AIDS.
authors.affiliation: Zhejiang Provincial Center for Diseases Control and Prevention, Hangzhou, China.
authors.forename: Lin
authors.initials: L
authors.lastname: Chen
authors.affiliation: Zhejiang Provincial Center for Diseases Control and Prevention, Hangzhou, China.
authors.forename: Jiezhe
authors.initials: J
authors.lastname: Yang
authors.affiliation: Zhejiang Provincial Center for Diseases Control and Prevention, Hangzhou, China.
authors.forename: Renjie
authors.initials: R
authors.lastname: Zhang
authors.affiliation: Zhejiang Provincial Center for Diseases Control and Prevention, Hangzhou, China.
authors.forename: Yun
authors.initials: Y
authors.lastname: Xu
authors.affiliation: Zhejiang Provincial Center for Diseases Control and Prevention, Hangzhou, China.
authors.forename: Jinlei
authors.initials: J
authors.lastname: Zheng
authors.affiliation: Zhejiang Provincial Center for Diseases Control and Prevention, Hangzhou, China.
authors.forename: Jianmin
authors.initials: J
authors.lastname: Jiang
authors.affiliation: Zhejiang Provincial Center for Diseases Control and Prevention, Hangzhou, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Jiang
authors.affiliation: Zhejiang Provincial Center for Diseases Control and Prevention, Hangzhou, China.
authors.forename: Lin
authors.initials: L
authors.lastname: He
authors.affiliation: National Center for AIDS/STD Control and Prevention, China CDC, Beijing, China.
authors.forename: Ning
authors.initials: N
authors.lastname: Wang
authors.affiliation: Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong.
authors.forename: Philip Chun
authors.initials: PC
authors.lastname: Yeung
authors.affiliation: Department of HIV/AIDS Prevention and Control, Zhejiang Provincial Center for Diseases Control and Prevention, 3399 Binsheng Road, Hangzhou, Zhejiang People's Republic of China.
authors.forename: Xiaohong
authors.initials: X
authors.lastname: Pan
keywords: AIDS; HAART; HIV