Research Article: Immunological and virologic outcomes of people living with HIV in Guangxi, China: 2012-2017

Date Published: March 1, 2019

Publisher: Public Library of Science

Author(s): Xueying Yang, Xiaoming Li, Shan Qiao, Quan Zhang, Zhiyong Shen, Yuejiao Zhou, Bharat S. Parekh.

http://doi.org/10.1371/journal.pone.0213205

Abstract

Limited data are available on clinical outcomes of people living with HIV (PLWH) in China, especially after the implementation of the 2016 national treatment guideline. The objective of the current study is to examine the treatment patterns, clinical outcomes and their associated factors among PLWH in Guangxi, China before and after this new guideline.

Data from three community-based projects conducted at different time points over a period of six years (2012–2017) in Guangxi were analyzed in our study. The interviewer-administered questionnaire was used for data collection. Measures of clinical outcomes were retrieved from the patients’ medical records. Descriptive analysis was employed to display treatment patterns and the time trends of clinical outcomes. Chi-square test or ANOVA was used to compare the differences in background characteristics and treatment history between different levels of clinical outcomes.

Among the pooled sample of 4224 participants, 77.3% were receiving antiretroviral therapy (ART), the median CD4 count was 328 cells/mm3, and 82.5% were virally suppressed. An increasing trend in both ART coverage (from 72.1% to 91.2%) and CD4 count (from 318 cells/mm3 to 357 cells/mm3) was observed over time in the three samples, while rates of viral suppression did not show a similar trend. A number of socio-demographic characteristics (e.g., female gender, younger age, Han ethnicity, and employment) and treatment-related variables (e.g., longer durations of HIV diagnosis and ART uptake, lower prevalence of comorbidity, fewer treatment interruptions, and more knowledge on ART) were associated with improved clinical outcomes.

We observed a high rate of viral suppression and increasing trends in ART coverage and CD4 count over six years in Guangxi, China. However, suboptimal clinical outcomes continue to be a problem, particularly among some subgroups of PLWH. Future clinical management strategies should be tailored for PLWH with different sociodemographic characteristics and treatment trajectories.

Partial Text

Antiretroviral therapy (ART) has been used worldwide and achieved great success in HIV treatment and prevention since its advent in the 1990s. The preventive benefits of the early use of ART in asymptomatic HIV infection have been proved with clinical evidence in the last decade [1, 2]. Furthermore, increasing evidence also documented various benefits of the early use of ART in substantially reducing AIDS-related morbidity and mortality [1, 3–6].

In our study, the ART coverage and rate of viral suppression (HIV RNA <50 copies/ml) were both relatively high across different time points among PLWH who received care in Guangxi. The rates are comparable with previous studies conducted in China [18, 26] and even higher than some developed countries [33]. However, the treatment outcomes were still behind the UNAIDS 90-90-90 targets [8]. The large proportion (around 50%) of lower CD4 counts (≤350 cells/mm3) also suggested a room for improvement in immune recovery, because the decline of CD4 count can lead to an increase of both opportunistic infections and mortality [34]. Expanding the HIV testing and improving early linkage to care could be helpful to get more PLWH on treatment before their immunological functioning become deteriorated.   Source: http://doi.org/10.1371/journal.pone.0213205

 

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