title: Improved survival in HIV treatment programmes in Asia.
abstract: Antiretroviral treatment (ART) for HIV-positive patients has expanded rapidly in Asia over the last 10 years. Our study aimed to describe the time trends and risk factors for overall survival in patients receiving first-line ART in Asia.
  
  
  
  We included HIV-positive adult patients who initiated ART between 2003-2013 (n=16,546), from seven sites across six Asia-Pacific countries. Patient follow-up was to May 2014. We compared survival for each country and overall by time period of ART initiation using Kaplan-Meier curves. Factors associated with mortality were assessed using Cox regression, stratified by site. We also summarized first-line ART regimens, CD4+T-cell count at ART initiation, and CD4+T-cell and HIV viral load testing frequencies.
  
  
  
  There were 880 deaths observed over 54,532 person-years of follow-up, a crude rate of 1.61 (95% CI 1.51, 1.72) per 100 person-years. Survival significantly improved in more recent years of ART initiation. The survival probability at 4 years follow-up for those initiating ART in 2003-2005 was 92.1%, 2006-2009 was 94.3% and 2010-2013 was 94.5% (P<0.001). Factors associated with higher mortality risk included initiating ART in earlier time periods, older age, male sex, injecting drug use as HIV exposure and lower pre-ART CD4+T-cell count. Concurrent with improved survival was increased tenofovir use, ART initiation at higher CD4+T-cell counts and greater monitoring of CD4+T-cells and HIV viral load.
  
  
  
  Our results suggest that HIV-positive patients from Asia have improved survival in more recent years of ART initiation. This is likely a consequence of improvements in treatment, patient management and monitoring over time.
authors.affiliation: The Kirby Institute, UNSW Australia, Sydney, NSW, Australia.
authors.forename: Nicole L
authors.initials: NL
authors.lastname: De La Mata
authors.affiliation: Chennai Antiviral Research and Treatment Clinical Research Site (CART CRS), YRGCARE Medical Centre, VHS, Chennai, India.
authors.forename: Nagalingeswaran
authors.initials: N
authors.lastname: Kumarasamy
authors.affiliation: National Center for HIV/AIDS, Dermatology & STDs, Phnom Penh, Cambodia.
authors.forename: Vohith
authors.initials: V
authors.lastname: Khol
authors.affiliation: Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore.
authors.forename: Oon Tek
authors.initials: OT
authors.lastname: Ng
authors.affiliation: National Hospital for Tropical Diseases, Hanoi, Vietnam.
authors.forename: Kinh
authors.initials: K
authors.lastname: Van Nguyen
authors.affiliation: Department of Internal Medicine, Faculty of Medicine Udayana University & Sanglah Hospital, Bali, Indonesia.
authors.forename: Tuti Parwati
authors.initials: TP
authors.lastname: Merati
authors.affiliation: Bach Mai Hospital, Hanoi, Vietnam.
authors.forename: Thuy Thanh
authors.initials: TT
authors.lastname: Pham
authors.affiliation: Department of Medicine, Queen Elizabeth Hospital, Hong Kong SAR, China.
authors.forename: Man Po
authors.initials: MP
authors.lastname: Lee
authors.affiliation: TREAT Asia, amfAR, The Foundation for AIDS Research, Bangkok, Thailand.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Durier
authors.affiliation: The Kirby Institute, UNSW Australia, Sydney, NSW, Australia.
authors.forename: Matthew
authors.initials: M
authors.lastname: Law
mesh_terms: D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D001208:Asia / Q000453:epidemiology; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000401:mortality* / Q000821:virology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D019562:Viral Load; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents