Causes of Death among AIDS Patients after Introduction of Free Combination Antiretroviral Therapy (cART) in Three Chinese Provinces, 2010-2011.
BACKGROUND
Although AIDS-related deaths have had significant economic and social impact following an increased disease burden internationally, few studies have evaluated the cause of AIDS-related deaths among patients with AIDS on combination anti-retroviral therapy (cART) in China. This study examines the causes of death among AIDS-patients in China and uses a methodology to increase data accuracy compared to the previous studies on AIDS-related mortality in China, that have taken the reported cause of death in the National HIV Registry at face-value.


METHODS
Death certificates/medical records were examined and a cross-sectional survey was conducted in three provinces to verify the causes of death among AIDS patients who died between January 1, 2010 and June 30, 2011. Chi-square analysis was conducted to examine the categorical variables by causes of death and by ART status. Univariate and multivariate logistic regression were used to evaluate factors associated with AIDS-related death versus non-AIDS related death.


RESULTS
This study used a sample of 1,109 subjects. The average age at death was 44.5 years. AIDS-related deaths were significantly higher than non-AIDS and injury-related deaths. In the sample, 41.9% (465/1109) were deceased within a year of HIV diagnosis and 52.7% (584/1109) of the deceased AIDS patients were not on cART. For AIDS-related deaths (n = 798), statistically significant factors included CD4 count <200 cells/mm3 at the time of cART initiation (AOR 1.94, 95%CI 1.24-3.05), ART naïve (AOR 1.69, 95%CI 1.09-2.61; p = 0.019) and age <39 years (AOR 2.96, 95%CI 1.77-4.96).


CONCLUSIONS
For the AIDS patients that were deceased, only those who initiated cART while at a CD4 count ≥200 cells/mm3 were less likely to die from AIDS-related causes compared to those who didn't initiate ART at all.
Division of Epidemiology, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
Liyan
L
Wang
Division of Epidemiology, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
Lin
L
Ge
Division of Epidemiology, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
Lu
L
Wang
University of South Florida, Morsani College of Medicine, Division of Infectious Disease and International Medicine, USF Medicine International, Tampa, Florida, United States of America.
Jamie P
JP
Morano
Division of Epidemiology, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
Wei
W
Guo
Yale School of Public Health, New Haven, Connecticut, United States of America.
Kaveh
K
Khoshnood
Division of Epidemiology, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
Qianqian
Q
Qin
Division of Epidemiology, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
Zhengwei
Z
Ding
Henan Center for AIDS/STD Control and Prevention, Henan Center for Disease Control and Prevention, Henan, China.
Dingyong
D
Sun
Jiangsu Center for AIDS/STD Control and Prevention, Jiangsu Center for Disease Control and Prevention, Jiangsu, China.
Xiaoyan
X
Liu
Yunnan Center for AIDS/STD Control and Prevention, Yunnan Center for Disease Control and Prevention, Yunnan, China.
Hongbing
H
Luo
Division of Intervention, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
Jonas
J
Tillman
Division of Epidemiology, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
Yan
Y
Cui
D000163:Acquired Immunodeficiency Syndrome / Q000150:complications / Q000188:drug therapy* / Q000401:mortality*; D000328:Adult; D000368:Aged; D023241:Antiretroviral Therapy, Highly Active; D002423:Cause of Death; D002681:China; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors