title: Superior Effects of Antiretroviral Treatment among Men Who have Sex with Men Compared to Other HIV At-Risk Populations in a Large Cohort Study in Hunan, China.
abstract: This study assesses association between CD4 level at initiation of antiretroviral treatment (ART) on subsequent treatment outcomes and mortality among people infected with HIV via various routes in Hunan province, China. Over a period of 10 years, a total of 7333 HIV-positive patients, including 553 (7.5%) MSM, 5484 (74.8%) heterosexuals, 1164 (15.9%) injection drug users (IDU) and 132 (1.8%) former plasma donors (FPD), were recruited. MSM substantially demonstrated higher initial CD4 cell level (242, IQR 167-298) than other populations (Heterosexuals: 144 IQR 40-242, IDU: 134 IQR 38-224, FPD: 86 IQR 36-181). During subsequent long-term follow up, the median CD4 level in all participants increased significantly from 151 cells/mm³ (IQR 43-246) to 265 cells/mm³ (IQR 162-380), whereas CD4 level in MSM remained at a high level between 242 and 361 cells/mm³. Consistently, both cumulative immunological and virological failure rates (10.4% and 26.4% in 48 months, respectively) were the lowest in MSM compared with other population groups. Survival analysis indicated that initial CD4 counts ≤ 200 cells/mm³ (AHR = 3.14; CI, 2.43-4.06) significantly contributed to HIV-related mortality during treatment. Timely diagnosis and treatment of HIV patients are vital for improving CD4 level and health outcomes.
authors.affiliation: Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC 3004, Australia. ssu27@student.monash.edu.|School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC 3004, Australia. ssu27@student.monash.edu.
authors.forename: Shu
authors.initials: S
authors.lastname: Su
authors.affiliation: Hunan Provincial Center for Disease Control and Prevention, Changsha 410005, Hunan, China. chenxi161@sohu.com.
authors.forename: Xi
authors.initials: X
authors.lastname: Chen
authors.affiliation: Center for Social Research in Health, Faculty of Arts and Social Science at the University of New South Wales, Sydney, NSW 2052, Australia. limin.mao@unsw.edu.au.
authors.forename: Limin
authors.initials: L
authors.lastname: Mao
authors.affiliation: Hunan Provincial Center for Disease Control and Prevention, Changsha 410005, Hunan, China. jmhe69@126.com.
authors.forename: Jianmei
authors.initials: J
authors.lastname: He
authors.affiliation: Hunan Provincial Center for Disease Control and Prevention, Changsha 410005, Hunan, China. isqq2011@163.com.
authors.forename: Xiuqing
authors.initials: X
authors.lastname: Wei
authors.affiliation: Comprehensive AIDS Research Center, Tsinghua University, Beijing 100084, China. jingjun@tsinghua.edu.cn.
authors.forename: Jun
authors.initials: J
authors.lastname: Jing
authors.affiliation: Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC 3004, Australia. lei.zhang1@monash.edu.|School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC 3004, Australia. lei.zhang1@monash.edu.|Comprehensive AIDS Research Center, Tsinghua University, Beijing 100084, China. lei.zhang1@monash.edu.|Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC 3004, Australia. lei.zhang1@monash.edu.
authors.forename: Lei
authors.initials: L
authors.lastname: Zhang
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D002681:China / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality*; D020010:Heterosexuality / Q000706:statistics & numerical data*; D018451:Homosexuality, Male / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D019562:Viral Load / Q000187:drug effects
chemical_list: D044966:Anti-Retroviral Agents
keywords: CD4; China; HIV; MSM; treatment failure; viral load