Abstract
Background: To estimate the influence of antiretroviral therapy (ART) initiation time， baseline CD4+ cell counts and other prognostic factors on AIDS-related death among former plasma donors patients (FPD). Methods: A retrospective cohort study was conducted involving 11,905 HIV/AIDS patients in a high-risk area of illicit blood donation of Henan province in China between 1995 and 2016. Demographic and clinical characteristics information was collected. Hazard Ratios (HRs) for AIDS-related mortality by categories of baseline CD4+ cell counts and ART initiation time, were determined using competing risk model. Competing risk model also was used to evaluate the prognostic factors of AIDS-related mortality. The model performance was assessed by time-dependent receiver operating characteristic curve. Results: Patients who initiated ART within 90 days of HIV/AIDS diagnosis (sHR: 0.24, 95% CI: 0.22-0.27) and baseline CD4+ cell counts of ≥500 cells/μL (sHR: 0.23, 95% CI: 0.19-0.28) were associated with lower AIDS-related mortality risk. ART initiation time >1 year and CD4+ counts >350 (sHR: 4.42, 95% CI: 3.30-5.91) had a higher AIDS-related mortality risk than ART initiation time >90 days and CD4+ counts ≤350 (sHR: 4.33, 95% CI: 3.58-5.23). Male (sHR: 1.32, 95% CI: 1.22-1.43), older age (sHR: 1.97, 95% CI: 1.59-2.46), and infection by blood transmission (sHR: 1.57, 95% CI: 1.37-1.80) were risk factors.Conclusions: Early ART should be promoted to improve the survival of HIV/AIDS patients regardless of baseline CD4+ cell counts, especially elders, males, and infected through blood transmission. Key words: HIV/AIDS; antiretroviral therapy; treatment initiation; CD4+ cell counts; AIDS-related mortality; competing risk model
Effect of antiretroviral therapy initiation time and baseline CD4+ cell counts on AIDS-related mortality among former plasma donors in China: a 21-year retrospective cohort study
