Immediate HIV treatment drastically reduces mortality in China

17 November 2017

Immediate antiretroviral treatment (ART) for people with low CD4 counts in China reduces overall mortality by 63% – confirming trials in other countries that have shown the benefit of early treatment for improved health outcomes.

A pharmacy in Hong Kong

Getting people on antiretroviral treatment (ART) as early as possible drastically reduces HIV-related deaths in China, according to new research published in Clinical Infectious Diseases.

World Health Organization (WHO) guidelines already call for people to start treatment as soon as possible after diagnosis, regardless of CD4 count. CD4 cells are white blood cells that HIV targets and destroys; a lower amount of these makes people more susceptible to illness because their immune system is compromised.

The study – a nationwide, observational cohort – looked retrospectively at mortality in people who were newly diagnosed with HIV between 1 January 2012 and 30 June 2014, and had a CD4 count of less than 500 cells/mm3.

Patients were followed for one year to examine the impact of immediate ART on mortality among people living with HIV with low CD4 counts (less than 500 cells/mm3), compared to those with delayed ART initiation and to those who remained ART-naïve. They also looked at the causes of death for this cohort.

Some 212,402 records were reviewed and a total of 34,581 individuals (16.3%) met the criteria of the study – that they were 18 years or older at the time of diagnosis, had a CD4 test result within one year of diagnosis, had baseline (pre-ART) CD4 count of less than 500 cells/mm3, and had reported acquiring HIV through heterosexual contact, male-to-male sexual contact, or injecting drug use.

5.3% of the group started treatment within 30 days of diagnosis (immediate ART group), 16.3% initiated ART after 30 days of diagnosis (delayed ART group), and 78.4% didn’t receive ART after one year (no-ART group).

Among the participants starting treatment within 30 days of diagnosis, they experienced a 63% reduction in overall mortality. The researchers also found that a higher risk of death was associated with older age, being male, having less education, and being infected via heterosexual contact or injecting drug use.

In the group that started ART immediately, no deaths were attributed to AIDS-related complications, with the most common cause of death being cardiovascular disease. Among those in the delayed ART group, 41.4% died from AIDS-related causes. While in the no ART group, the majority of deaths were documented as being non-AIDS-related (77.6%).

The study authors remarked: “Our results highlight the significant negative impact of delays in ART initiation in a real-world setting in China.”
In their discussion, the authors note that arguments to delay ART initiation based on CD4 cell count threshold include concerns about drug resistance, side effects, resource allocation, and adherence – but that the benefits of immediate ART-initiation far outweigh these risks.

The authors concluded: “Our results support the urgent need to increase the number of people living with HIV identified early and started on effective, long-term ART immediately as predicated by the United Nations 90-90-90 targets.”

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Written by Caitlin Mahon

Content Specialist - HIV & Sexual Health