Effect of Late Testing and Antiretroviral Treatment on Mortality Among People Living With HIV in the Era of Treat-All in Guangdong Province, China, 1992–2018: A Cohort Study
Late testing and antiretroviral therapy (ART) prevailed among people living with HIV (PLHIV) and impacted the benefit of immediate ART. This study aimed to identify the benefit of the test-and-immediate-treat policy in China, the effect of immediate ART, and the influence of late testing and ART on...
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Frontiers Media S.A.
2022-07-01
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| Series: | Frontiers in Public Health |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fpubh.2022.851117/full |
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| author | Qiaosen Chen Jun Liu Xiaobing Fu Fang Yang Qicai Liu Junbin Li Zhimin Tan Jing Li Kaihao Lin Yao Yan Yi Yang Yan Li Hongbo Jiang |
| author_facet | Qiaosen Chen Jun Liu Xiaobing Fu Fang Yang Qicai Liu Junbin Li Zhimin Tan Jing Li Kaihao Lin Yao Yan Yi Yang Yan Li Hongbo Jiang |
| author_sort | Qiaosen Chen |
| collection | DOAJ |
| description | Late testing and antiretroviral therapy (ART) prevailed among people living with HIV (PLHIV) and impacted the benefit of immediate ART. This study aimed to identify the benefit of the test-and-immediate-treat policy in China, the effect of immediate ART, and the influence of late testing and ART on the whole PLHIV in Guangdong Province, China. We designed two tendency analyses in aggregative form and two cohorts (surveillance and ART cohort) in individuals' perspectives based on the HIV/AIDS Comprehensive Response Information Management System. Two interrupted time series models were conducted for tendency analysis from 2009 to 2018 to explore the all-cause and short-term mortality decrease after the test-and-immediate-treat policy. A time-dependent Cox model was performed for the surveillance cohort from 1992 to 2018 and a joint model was utilized for the ART cohort to identify the effect of immediate ART and the influence of late testing and ART on death. The tendency analysis included 324,914 and 68,679 person-year for all-cause/short-term mortality. A total of 49,289 and 26,287 PLHIV were recruited in the surveillance and ART cohort with 5,557 and 459 deaths, respectively. The short-term mortality dropped from 4.69 cases/100 person-year in January 2009 to 0.35 cases/100 person-year in December 2018 (standardized rate). The all-cause mortality saw a decreasing trend from 1.46 cases/100 person-year in January 2009 to 0.14 cases/100 person-year in December 2018 (standardized rate). The tendency analysis showed a significant short-term mortality slope decrease after the test-and-immediate-treat policy (P = 0.024). From the surveillance cohort, late testing, in general, was a risk factor for all-cause mortality [hazard ratio (HR) = 1.330, 95% CI, 1.250, 1.416]. ART cohort showed higher hazards of all-cause mortality among PLHIV with no late testing, but late ART (HR = 1.690, 95% CI, 1.166, 2.451) and both the late testing and late ART (HR = 1.335, 95% CI, 1.042, 1.710). Immediate ART might decrease the hazard of all-cause death though it is insignificant (HR = 0.923, 95% CI: 0.755, 1.129) in the ART cohort. The test-and-immediate-test policy brought benefit to PLHIV. We should enlarge HIV testing using comprehensive approaches to decrease late testing and ART and increase the benefit of immediate ART. |
| first_indexed | 2024-04-13T22:09:54Z |
| format | Article |
| id | doaj.art-4bc8092efd8642fb832953314a48683a |
| institution | Directory Open Access Journal |
| issn | 2296-2565 |
| language | English |
| last_indexed | 2024-04-13T22:09:54Z |
| publishDate | 2022-07-01 |
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| spelling | doaj.art-4bc8092efd8642fb832953314a48683a2022-12-22T02:27:46ZengFrontiers Media S.A.Frontiers in Public Health2296-25652022-07-011010.3389/fpubh.2022.851117851117Effect of Late Testing and Antiretroviral Treatment on Mortality Among People Living With HIV in the Era of Treat-All in Guangdong Province, China, 1992–2018: A Cohort StudyQiaosen Chen0Jun Liu1Xiaobing Fu2Fang Yang3Qicai Liu4Junbin Li5Zhimin Tan6Jing Li7Kaihao Lin8Yao Yan9Yi Yang10Yan Li11Hongbo Jiang12Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, ChinaDepartment of HIV/AIDS Control and Prevention, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, ChinaDepartment of HIV/AIDS Control and Prevention, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, ChinaDepartment of HIV/AIDS Control and Prevention, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, ChinaGuangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, ChinaGuangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, ChinaDepartment of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, ChinaDepartment of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, ChinaDepartment of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, ChinaDepartment of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, ChinaDepartment of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, ChinaDepartment of HIV/AIDS Control and Prevention, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, ChinaDepartment of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, ChinaLate testing and antiretroviral therapy (ART) prevailed among people living with HIV (PLHIV) and impacted the benefit of immediate ART. This study aimed to identify the benefit of the test-and-immediate-treat policy in China, the effect of immediate ART, and the influence of late testing and ART on the whole PLHIV in Guangdong Province, China. We designed two tendency analyses in aggregative form and two cohorts (surveillance and ART cohort) in individuals' perspectives based on the HIV/AIDS Comprehensive Response Information Management System. Two interrupted time series models were conducted for tendency analysis from 2009 to 2018 to explore the all-cause and short-term mortality decrease after the test-and-immediate-treat policy. A time-dependent Cox model was performed for the surveillance cohort from 1992 to 2018 and a joint model was utilized for the ART cohort to identify the effect of immediate ART and the influence of late testing and ART on death. The tendency analysis included 324,914 and 68,679 person-year for all-cause/short-term mortality. A total of 49,289 and 26,287 PLHIV were recruited in the surveillance and ART cohort with 5,557 and 459 deaths, respectively. The short-term mortality dropped from 4.69 cases/100 person-year in January 2009 to 0.35 cases/100 person-year in December 2018 (standardized rate). The all-cause mortality saw a decreasing trend from 1.46 cases/100 person-year in January 2009 to 0.14 cases/100 person-year in December 2018 (standardized rate). The tendency analysis showed a significant short-term mortality slope decrease after the test-and-immediate-treat policy (P = 0.024). From the surveillance cohort, late testing, in general, was a risk factor for all-cause mortality [hazard ratio (HR) = 1.330, 95% CI, 1.250, 1.416]. ART cohort showed higher hazards of all-cause mortality among PLHIV with no late testing, but late ART (HR = 1.690, 95% CI, 1.166, 2.451) and both the late testing and late ART (HR = 1.335, 95% CI, 1.042, 1.710). Immediate ART might decrease the hazard of all-cause death though it is insignificant (HR = 0.923, 95% CI: 0.755, 1.129) in the ART cohort. The test-and-immediate-test policy brought benefit to PLHIV. We should enlarge HIV testing using comprehensive approaches to decrease late testing and ART and increase the benefit of immediate ART.https://www.frontiersin.org/articles/10.3389/fpubh.2022.851117/fullpeople living with HIVlate testinglate antiretroviral treatmenttreat-allmortalitytrend |
| spellingShingle | Qiaosen Chen Jun Liu Xiaobing Fu Fang Yang Qicai Liu Junbin Li Zhimin Tan Jing Li Kaihao Lin Yao Yan Yi Yang Yan Li Hongbo Jiang Effect of Late Testing and Antiretroviral Treatment on Mortality Among People Living With HIV in the Era of Treat-All in Guangdong Province, China, 1992–2018: A Cohort Study Frontiers in Public Health people living with HIV late testing late antiretroviral treatment treat-all mortality trend |
| title | Effect of Late Testing and Antiretroviral Treatment on Mortality Among People Living With HIV in the Era of Treat-All in Guangdong Province, China, 1992–2018: A Cohort Study |
| title_full | Effect of Late Testing and Antiretroviral Treatment on Mortality Among People Living With HIV in the Era of Treat-All in Guangdong Province, China, 1992–2018: A Cohort Study |
| title_fullStr | Effect of Late Testing and Antiretroviral Treatment on Mortality Among People Living With HIV in the Era of Treat-All in Guangdong Province, China, 1992–2018: A Cohort Study |
| title_full_unstemmed | Effect of Late Testing and Antiretroviral Treatment on Mortality Among People Living With HIV in the Era of Treat-All in Guangdong Province, China, 1992–2018: A Cohort Study |
| title_short | Effect of Late Testing and Antiretroviral Treatment on Mortality Among People Living With HIV in the Era of Treat-All in Guangdong Province, China, 1992–2018: A Cohort Study |
| title_sort | effect of late testing and antiretroviral treatment on mortality among people living with hiv in the era of treat all in guangdong province china 1992 2018 a cohort study |
| topic | people living with HIV late testing late antiretroviral treatment treat-all mortality trend |
| url | https://www.frontiersin.org/articles/10.3389/fpubh.2022.851117/full |
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