Analysis on HIV suppression effect after initiating antiretroviral treatment and related factors among AIDS patients in Henan province during 2008 and 2013

Objective To compare the HIV suppression rate after initiating antiretroviral treatment (ART) among AIDS patients at different immunological levels and to analyze the related factors. Methods Data on AIDS patients initially starting antiretroviral therapy during 2008 and 2013 were collected from Chinese HIV/AIDS integrated control system. All the participants were divided into early treatment group (baseline CD4+T cell counts between 351/μl and 500/μl) and conventional treatment group (baseline CD4+T cell counts≤350/μl). The rates of comprehensive virologic suppression at different time nodes after the initiation of ART were analyzed accordingly. Unconditional logistic regression model was adopted to examine the factors associated with the failure of viral suppression after 6 months after initiation of ART. Results A total of 16 103 cases were selected, among which, 1 581 cases were early treatment group, and 14 522 cases were conventional treatment group. A total of 9 428 cases were males, 6 675 cases were females, and the sex ratio was 1.41∶1. The age was 47.2±11.7, and 71.55% (11 522/16 103) of cases were married or cohabiting, 57.22% (9 214/16 103) were transmitted by blood. 81.26% (13 086/16 103) were cures in the township or village treatment institution, and 77.17% (12 426/16 103) received the ART regimen as Stavudine (D4T) or Zidovudine (AZT) +Lamivudine (3TC) +Nevirapine (NVP) or Efevirenz (EFV). After 0.5, 1, 2, 3, 4, 5 and 6 years after the initiation of ART, the rates of virologic suppression in the conventional treatment cohort were 72.6% (3 008/4 144), 73.9% (4 758/6 443), 74.1% (3 641/4 915), 74.9% (2 819/3 766), 76.1% (1 729/2 272) and 78.2% (492/629), respectively. While the rates of viral suppression in the early treatment cohort at the same time nodes were 65.5% (315/481), 65.4% (448/685), 68.8% (223/324), 66.0% (155/235), 71.4% (110/154) and 61% (30/49), respectively, and the differences between the two groups were significant (P<0.05) except at the fourth year. Non-conditional logistic regression analysis showed that in the conventional treatment group, factors associated with low HIV suppression rate were male (OR=1.23, 95%CI: 1.07-1.42), longer time interval from confirmed HIV infection to received ART (OR=1.26, 95%CI: 1.16-1.36), using D4T/AZT+ DDI +NVP/EFV as initial treatment regimen (OR=3.00, 95%CI: 2.26-3.98) and nearly missing doses for 7 days at treatment of six months (OR=1.97, 95%CI: 1.22-3.18) and factors associated with high HIV suppression rate were infected through homosexual transmission route (OR=0.57, 95%CI: 0.35-0.90) and treated in the county level medical institution or above (OR=0.61, 95%CI: 0.50-0.75). Among early treatment group, cases who received treatment at county level medical institution or above had high HIV suppression rate (OR=0.43, 95%CI: 0.23-0.80) and objects with longer time interval from confirmed HIV infection to receive ART had low HIV suppression rate (OR=1.43, 95%CI: 1.09-1.88). Conclusion The viral suppression efficacy among AIDS patients with different baseline immunologic levels after treatment was similarly satisfactory. AIDS cases who received ART at county level medical institution or above had better viral suppression effect and patients with longer time interval from confirmation to treatment had poor HIV suppression effect. Key words: Acquired immunodeficiency syndrome; Retrospective studies; Antiretroviral treatment; HIV suppression; Factor analysis, statistical