Preliminary Assessment Of Virological, Immunological Outcomes And Associated Factors Among HIV/AIDS Patients Received Antiretroviral Therapy

Section1Preliminary assessment of virological, immunological failure and associated factors among HIV/AIDS patients received antiretroviral therapy in parts of China[Background] Viral load (VL) and both CD4+T cell counts of HIV infection determine whether the infection started ART is based, but also to assess the effect of ART main indicators. China national AIDS policy implementation antiretroviral therapy (ART) has been more than ten years,286thousands patients began receiving ART. In the year2007free testing program was began, but due to the lack of technical personnel and laboratory testing resources in the treatment of many AIDS patients are still unable to obtain timely detection of VL and CD4+T cell counts and ART assessment. Expanded detection of VL and detect CD4+T cell counts can not only accurately assess treatment failure, and medication compliance can be achieved and whether the reasonable use of the role of second-line therapy monitoring of patients.[Objective] Understanding preliminary assessment of virological, immunological failure and the associated factors in HIV-1patients with implemented VL and CD4+T cell count monitoring will provide important information for HIV/AIDS treatment policy. To investigate factors associated with ART modification owing to ADRs in antiretroviral-naive HIV-infected individuals, and to assess the associated factors of ART regimen modification. [Methods] Open cohort evaluation of antiretroviral-naive adults enrolled between2003and2006. Data were entered in real time into an electronic patient tracking system between January2003and October2010. Those meeting criteria for ART received drugs according to national guidelines. The endpoints were virological failure and immunological failure, defined by based on WHO guidelines, the probabilities of which were assessed using Kaplan-Meier curves.virological failure, immunological failure and ART modification associated risk factors for each outcome were determined using Cox proportional hazard regression.[Results]1,037patients were followed for a total of5,169person-years. Over the seven years of follow up a total of323(31%) patients experienced virological failure and264(25%) experienced immunological failure, for overall failure rates of7.5per100person-years (95%confidence interval [CI]:6.7-8.3) and5.7per100person-years (95%CI:5.1-6.5), respectively. Compared to village clinic, superior level of medical institution was associated with a lowly hazard of virological failure among long-term ART at city level hospital (adjusted hazard ratio [AHR]=0.50,95%CI:0.15-0.36), county level (AHR=0.61,95%CI:0.43-0.85). Atotal of372(36.36%) patients had the type of regimen change caused by ADRs, which gives an overall rate of8.7per100person-years (95%CI:7.9-9.8). The use of didanosine or efavirenz was associated with higher regimen change rates. The most represented ADRs which were caused to changes in first-line regimens were peripheral neuritis (21.24%), nausea and vomiting (21.24%), liver dysfunction (20.97%), rash (17.47%), bone marrow suppression (11.56%). Compared to village clinic, prefecture level hospital/CDC institution was changed to a risk factor for changes in first-line regimens due to ADRs (AHR=2.10,95%CI:1.41-3.11).[Conclusions] The study found the treatment of patients treated in primary health care institutions generally appear higher virological and immunological failure rate, suggesting the need to strengthen the allocation of resources and facilities primary health ART. Route of infection, medical institutions are associated with virological and immunological failure. Because risk of ADRs increased with duration of treatment continue, the need for ADRs should appear timely monitoring and assessment, and can accurately and timely replacement regimen. For the cause of more serious ADRs and other drug didanosine, promoting the use of new anti-retrovirals (ARVs) replacement therapy, increase compliance and drug safety to treat patients as possible. Section2The absence of CD4+T cell recovery to antiretroviral therapy despite full viral suppression HIV-1infection[Background] Some HIV-1infected individuals initiating combination antiretroviral therapy (cART) with low CD4+T cell counts achieve viral suppression but not CD4+T cell counts recovery. Several studies have shown that individuals with successful virological response to cART and incomplete CD4+T cell counts recovery have increased AIDS and mortality. As some people experience poor immunological responses despite virologically effective long-term ART, it remains important to investigate the risk of failing to achieve recovery to key thresholds despite regular engagement in HIV care and consistent viral load suppression, particularly among people starting ART with low CD4+T cell counts.[Objectives] To assess CD4+T cell recovery in people severely immunosuppressed at start of ART who achieve and maintain viral load suppression throughout follow-up and identify risk factors for failure to achieve CD4+T cell count>350cell/μL by the time of the last follow-up.[Methods] Eligible participants from Shenzhen City HIV cohort study started ART with at least1year. Participants were required to have pre-ART CD4+T cell count below100cell/μL, at least1year of follow-up on ART, have achieved viral load suppression (≤50copies/mL) by9months after starting ART and to have maintained this throughout follow-up. Participants were further required to be regularly engaged with care. We calculated the proportion of people who failed to achieve a CD4+T cell count of more than100,150,200,350and500cell/μL by the time of the latest follow-up. The probabilities of which were assessed using Kaplan-Meier curves. Associated risk factors for each outcome were identified using Cox proportional hazard regression.[Results] Of the293participants [median (interquartile range, IQR) pre-ART CD4+T cell count of32(14-66) cell/μL],3(1%),18(6.1%),29(9.9%),131(44.7%) and32(10.9%), failed to achieve a CD4+T cell count of more than100,150,200,350and500cell/μL, by the censoring date, respectively. Kaplan-Meier estimates of the proportion of people reaching each CD4+T cell count threshold after1year on ART were81.6,57,34.5,3.8and0.3%, respectively, and after3years on ART,97.6,89.9,83.5,37.1and8.9%, respectively. Median (IQR) follow-up on ART was3.2(2.5-4.6) years.[Conclusion] Given a person with pre-ART CD4+T cell count below100cell/μL survives and maintains consistent viral suppression on ART, there is over a80%chance of reaching a CD4+T cell count above200cell/μL by3years.