Mortality Risk Factors Among People Living with HIV Receiving Second-line Antiretroviral Therapy in Rural China
- Authors: Kang Q.1, Pan W.2, Ma Y.3, Wang D.1, Jia H.1, Guo H.4, Sang F.5, Xu L.4, Xu Q.6, Jin Y.4
 - 
							Affiliations: 
							
- The First Clinical Medical School, Henan University of Chinese Medicine
 - The First Clinical Medical Schoo, Henan University of Chinese Medicin
 - Center for AIDS/STD Control and Prevention, Center for Disease Control and Prevention of Henan Province
 - Department of Acquired Immune Deficiency Syndrome Treatment and Research Center, First Affiliated Hospital of Henan University of Chinese Medicine
 - Henan Key Laboratory of Viral Diseases Prevention and Treatment of Chinese Medicine, Henan University of Chinese Medicine, Zhengzhou
 - The First Clinical Medical School, Henan University of Chinese Medicine,
 
 - Issue: Vol 22, No 2 (2024)
 - Pages: 100-108
 - Section: Medicine
 - URL: https://clinpractice.ru/1570-162X/article/view/644029
 - DOI: https://doi.org/10.2174/011570162X280721240108065502
 - ID: 644029
 
Cite item
Full Text
Abstract
Background:Second-line antiretroviral therapy (ART) was introduced in Henan Province in 2009. The number of people living with human immunodeficiency virus (HIV) starting this therapy is increasing.
Objective:This study aimed to investigate the survival and factors affecting mortality among this group.
Methods:We conducted a retrospective cohort study of people living with HIV (PLHIV) who switched to second-line ART between May 1, 2010, and May 1, 2016, using the KaplanMeier method and Cox proportional hazards models.
Results:We followed 3,331 PLHIV for 26,988 person-years, of whom 508 (15.3%) died. The mortality rate was 1.88/100 person-years. After adjusting for confounding factors, we found being a woman (hazard ratio (HR), 0.66; 95% confidence interval (CI) 0.550.79), > 50 years old (HR, 2.69; 95% CI, 2.033.56), single/widowed (HR, 1.26; 95% CI, 1.041.52), having > 6 years of education (HR, 0.78; 95% CI, 0.650.94), Chinese medicine (HR, 0.75; 95% CI, 0.520.96), liver injury (HR, 1.58; 95% CI, 1.192.10), and CD4+ T cell counp <000 cells/µl (HR, 1.94; 95% CI, 1.47-2.55), or 200-350 cells/µl (HR, 1.37; 95% CI, 1.031.82) were associated with mortality risk.
Conclusions:We found lower mortality among PLHIV who switched to second-line ART than most previous studies. The limitations of a retrospective cohort may, therefore, have biased the data, and prospective studies are needed to confirm the results. Moreover, Chinese medicine combined with second-line ART shows potential as a treatment for HIV.
About the authors
Qiujia Kang
The First Clinical Medical School, Henan University of Chinese Medicine
														Email: info@benthamscience.net
				                					                																			                												                														
Wanqi Pan
The First Clinical Medical Schoo, Henan University of Chinese Medicin
														Email: info@benthamscience.net
				                					                																			                												                														
Yanmin Ma
Center for AIDS/STD Control and Prevention, Center for Disease Control and Prevention of Henan Province
														Email: info@benthamscience.net
				                					                																			                												                														
Dongli Wang
The First Clinical Medical School, Henan University of Chinese Medicine
														Email: info@benthamscience.net
				                					                																			                												                														
Huangchao Jia
The First Clinical Medical School, Henan University of Chinese Medicine
														Email: info@benthamscience.net
				                					                																			                												                														
Huijun Guo
Department of Acquired Immune Deficiency Syndrome Treatment and Research Center, First Affiliated Hospital of Henan University of Chinese Medicine
														Email: info@benthamscience.net
				                					                																			                												                														
Feng Sang
Henan Key Laboratory of Viral Diseases Prevention and Treatment of Chinese Medicine, Henan University of Chinese Medicine, Zhengzhou
														Email: info@benthamscience.net
				                					                																			                												                														
Liran Xu
Department of Acquired Immune Deficiency Syndrome Treatment and Research Center, First Affiliated Hospital of Henan University of Chinese Medicine
														Email: info@benthamscience.net
				                					                																			                												                														
Qianlei Xu
The First Clinical Medical School, Henan University of Chinese Medicine,
							Author for correspondence.
							Email: info@benthamscience.net
				                					                																			                												                														
Yantao Jin
Department of Acquired Immune Deficiency Syndrome Treatment and Research Center, First Affiliated Hospital of Henan University of Chinese Medicine
							Author for correspondence.
							Email: info@benthamscience.net
				                					                																			                												                														
References
- Unaids. Global AIDS update. 2020. Available from: https://www.unaids.org/sites/default/files/media_asset/2020_global-aids-report_en.pdf
 - Barik SK, Bansal AK, Mohanty PS, et al. Detection of drug resistance mutations in the reverse transcriptase gene of hiv-1-infected north indian population failing first-line antiretroviral therapy "a follow-up cohort study". AIDS Res Hum Retroviruses 2021; 37(10): 796-805. doi: 10.1089/aid.2020.0132 PMID: 33390085
 - Alene M, Awoke T, Yenit MK, Tsegaye AT, Yismaw L, Yeshambel R. Second-line antiretroviral therapy regimen change among adults living with HIV in Amhara region: a multi-centered retrospective follow-up study. BMC Res Notes 2019; 12(1): 407. doi: 10.1186/s13104-019-4429-3 PMID: 31307513
 - Martinez-Vega R, De La Mata NL, Kumarasamy N, et al. Durability of antiretroviral therapy regimens and determinants for change in HIV-1-infected patients in the TREAT Asia HIV Observational Database (TAHOD-LITE). Antivir Ther 2018; 23(2): 167-78. doi: 10.3851/IMP3194 PMID: 28933705
 - Sam M, Masaba JPM, Alio D, Byakika-Tusiime J. Treatment failure and associated factors among individuals on second line antiretroviral therapy in Eastern Uganda: A retrospective cohort study. Infect Dis 2021; 14(1786337211014518) doi: 10.1177/11786337211014518 PMID: 34121842
 - Edessa D, Sisay M, Asefa F. Second-line HIV treatment failure in sub-Saharan Africa: A systematic review and meta-analysis. PLoS One 2019; 14(7): e0220159. doi: 10.1371/journal.pone.0220159 PMID: 31356613
 - Zenebe Haftu A, Desta AA, Bezabih NM, et al. Incidence and factors associated with treatment failure among HIV infected adolescent and adult patients on second-line antiretroviral therapy in public hospitals of Northern Ethiopia: Multicenter retrospective study. PLoS One 2020; 15(9): e0239191. doi: 10.1371/journal.pone.0239191 PMID: 32986756
 - WHO. Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV Infection: Recommendations for a public health approach. 2013. Available from : https://www.who.int/publications/i/item/9789241549684
 - Development of china free art manual. Available from: http://www.aizhi.org/UploadSoft/2005321103838886.pdf
 - Gao L, Xia H, Zeng R, et al. Pre-treatment and acquired antiretroviral drug resistance among people living with HIV in Tianjin, China. HIV Med 2022; 23(S1) (Suppl. 1): 84-94. doi: 10.1111/hiv.13252 PMID: 35293099
 - Chen J, Zhang M, Shang M, Yang W, Wang Z, Shang H. Research on the treatment effects and drug resistances of long-term second-line antiretroviral therapy among HIV-infected patients from Henan Province in China. BMC Infect Dis 2018; 18(1): 571. doi: 10.1186/s12879-018-3489-7 PMID: 30442114
 - Dou Z, Chen RY, Wang Z, et al. HIV-infected former plasma donors in rural central china: From infection to survival outcomes, 1985-2008. PLoS One 2010; 5(10): e13737. doi: 10.1371/journal.pone.0013737 PMID: 21060835
 - Zhang F, Wang Y, Wang J. Handbook of China's free ART program. Cell Research 2012; 15: 877-82.
 - Xu Q, Guo H, Jin Y, et al. Advantages of chinese medicine for patients with acquired immunodeficiency syndrome in rural central china. Chin J Integr Med 2018; 24(12): 891-6. doi: 10.1007/s11655-017-2418-8 PMID: 28887810
 - Jin Y, Zhang M, Ma Y, et al. Effects of chinese medicine on the survival of aids patients administered second-line ART in rural areas of china: A retrospective cohort study based on real-world data. Evid Based Complement Alternat Med 2022; 2022: 5103768. doi: 10.1155/2022/5103768
 - Jin Y, Meng X, Liu S, et al. Prevalence trend and risk factors for anemia among patients with human immunodeficiency virus infection receiving antiretroviral therapy in rural China. J Tradit Chin Med 2019; 39(1): 111-7.
 - Liang Y, Yang W J, Sun D Y, et al. Survival analysis on former plasma donors living with HIV/AIDS after initiation of antiretroviral therapy in Henan province. Zhonghua Liu Xing Bing Xue Za Zhi 2019; 40(6): 638-42. doi: 10.3760/cma.j.issn.0254-6450.2019.06.007
 - Zhu J, Gao R, Zhao S, et al. Chinese guidelines for prevention and treatment of dyslipidemia in adults (2016 Revision). Chin J Circulat 2016; 31(10): 937-53.
 - Tsung I, Dolan R, Lao CD, et al. Liver injury is most commonly due to hepatic metastases rather than drug hepatotoxicity during pembrolizumab immunotherapy. Aliment Pharmacol Ther 2019; 50(7): 800-8. doi: 10.1111/apt.15413 PMID: 31309615
 - Hematology Branch of Chinese Medical Association. Multidisciplinary expert consensus on the diagnosis, treatment and prevention of iron deficiency and iron deficiency anemia (2022 edition). Chin Med J 2022; 102(41): 3246-56. J. doi: 10.3760/cma.j.cn112137-20220621-01361
 - Cao W J, Yao Y M, Wei W, et al. Survival time and related factors on HIV/AIDS patients in Guizhou province from 1995 to 2018. Zhonghua Liu Xing Bing Xue Za Zhi 2020; 41(4): 557-61. doi: 10.3760/cma.j.cn112338-20190604-00395
 - Tsegaye AT, Alemu W, Ayele TA. Incidence and determinants of mortality among adult HIV infected patients on second-line antiretroviral treatment in Amhara region, Ethiopia: a retrospective follow up study. Pan Afr Med J 2019; 33: 89. doi: 10.11604/pamj.2019.33.89.16626 PMID: 31489067
 - Gao D, Zou Z, Dong B, et al. Secular trends in HIV/AIDS mortality in China from 1990 to 2016: Gender disparities. PLoS One 2019; 14(7): e0219689. doi: 10.1371/journal.pone.0219689 PMID: 31318900
 - Mangal TD, Meireles MV, Pascom ARP, de Almeida Coelho R, Benzaken AS, Hallett TB. Determinants of survival of people living with HIV/AIDS on antiretroviral therapy in Brazil 20062015. BMC Infect Dis 2019; 19(1): 206. doi: 10.1186/s12879-019-3844-3 PMID: 30819120
 - Zhu K, Xu Q, Ma Y, et al. Suboptimal immune recovery and associated factors among people living with HIV/AIDS on second-line antiretroviral therapy in central China: A retrospective cohort study. J Med Virol 2022; 94(10): 4975-82. doi: 10.1002/jmv.27944 PMID: 35710693
 - Ahn MY, Jiamsakul A, Khusuwan S, et al. The influence of age-associated comorbidities on responses to combination antiretroviral therapy in older people living with HIV. J Int AIDS Soc 2019; 22(2): e25228. doi: 10.1002/jia2.25228 PMID: 30803162
 - Ross J, Jiamsakul A, Kumarasamy N, et al. Virological failure and HIV drug resistance among adults living with HIV on second-line antiretroviral therapy in the Asia-Pacific. HIV Med 2020; 22(3): 201-11. doi: 10.1111/hiv.13006 PMID: 33151020
 - Marchionatti A, Parisi MM. Anemia and thrombocytopenia in people living with HIV/AIDS: A narrative literature review. Int Health 2021; 13(2): 98-109. doi: 10.1093/inthealth/ihaa036 PMID: 32623456
 - Deressa T, Damtie D, Workineh M, Genetu M, Melku M. Anemia and thrombocytopenia in the cohort of HIV-infected adults in northwest Ethiopia: A facility-based cross-sectional study. EJIFCC 2018; 29(1): 36-47. PMID: 29765285
 - Nigussie F, Alamer A, Mengistu Z, Tachbele E. Survival and predictors of mortality among adult HIV/AIDS patients initiating highly active antiretroviral therapy in debre-berhan referral hospital, amhara, ethiopia: A retrospective study. HIV AIDS 2020; 12: 757-68. doi: 10.2147/HIV.S274747 PMID: 33239921
 - Verna EC. Non-alcoholic fatty liver disease and non-alcoholic steatohepatitis in patients with HIV. Lancet Gastroenterol Hepatol 2017; 2(3): 211-23. doi: 10.1016/S2468-1253(16)30120-0 PMID: 28404136
 - Taborelli M, Suligoi B, Toffolutti F, et al. Excess liver-related mortality among people with AIDS compared to the general population: An Italian nationwide cohort study using multiple causes of death. HIV Med 2020; 21(10): 642-9. doi: 10.1111/hiv.12937 PMID: 32876382
 - Jin Y, Wang X, Li Z, et al. Survival of AIDS patients treated with traditional chinese medicine in rural central china: A retrospective cohort study, 2004-2012. Evid Based Complement Alternat Med 2015; 2015: 1-7. doi: 10.1155/2015/282819 PMID: 25821482
 - Wang Y, Jin F, Wang Q, et al. Long-term survival of AIDS patients treated with only traditional chinese medicine. Altern Complement Ther 2017; 23(2): 60-2. doi: 10.1089/act.2017.29106.ywa
 - Li X, Li H, Li C, Xia W, Li A, Li W. Traditional chinese medicine can improve the immune reconstruction of HIV/AIDS patients. AIDS Res Hum Retroviruses 2020; 36(4): 258-9. doi: 10.1089/aid.2019.0274 PMID: 31958968
 - Wang D, Ma S, Ma Y, et al. Effect of traditional chinese medicine therapy on the trend in CD4+ T-Cell counts among patients with HIV/AIDS treated with antiretroviral therapy: A retrospective cohort study. Evid Based Complement Alternat Med 2021; 2021: 5576612. doi: 10.1155/2021/5576612
 
Supplementary files
				
			
					
						
						
						
						
									