Survival analysis of patients receiving antiretroviral treatment in integrated HIV/AIDS prevention and treatment demonstration zone of Chongqing，China，2016-2021

Abstract:

Objective To investigate the survival status of patients living with human immunodeficiency virus（HIV）/acquired immunodeficiency syndrome（AIDS） receiving antiretroviral therapy in the integrated HIV prevention and treatment demonstration zone of Chongqing，China，and to explore the factors influencing patients’ survival.Methods A retrospective cohort study was performed to analyze the survival of patients aged ≥18 years who received antiretroviral treatment for the first time in the demonstration zone from 2016 to 2021. The survival rate was calculated by using the life-table method. The risk factors affecting death were analyzed using a Cox proportional hazards model.Results A total of 21 506 subjects were included in the study. A total of 54 919.63 person-years were followed up. The all-cause mortality rate was 3.67/100 person-years. The cumulative survival rates of 12，36，and ≥72 months since the initiation of antiretroviral therapy were 94.09%，88.65%，and 82.98%，respectively. The multivariable Cox proportional hazards regression analysis showed that the death risk of women was 0.54 times that of men. The risk of death for patients with treatment initiated at age of ≥60 years was 4.38 times that of those with treatment initiated at age of 18-30 years. The death risk of homosexually transmitted infection was 0.65 times that of heterosexually transmitted infection. In terms of the baseline number of CD4⁺ T cells，the risks of death in the groups of 200-349 cells/μL and ≥350 cells/μL were 0.61 and 0.49 times that of the group of 0-199 cells/μL，respectively. In terms of the interval between diagnosis and treatment，compared with the group of <30 days，the groups of 31-90 days，91-365 days，and >365 days were 1.25，1.56，and 1.74 times more likely to die of HIV/AIDS，respectively. The death risks with other first-line treatments and second-line treatments were 1.47 and 1.65 times that with standard first-line treatments，respectively.Conclusion The mortality rate is decreased in patients with HIV/AIDS receiving antiretroviral therapy in the Chongqing demonstration zone. Early detection and treatment of HIV/AIDS should be strengthened for patients with a high risk of death，those with treatment beginning at age of ≥60 years，a low baseline CD4⁺ T cell count，and a long interval between diagnosis and first treatment.