Impact of initiation of combination antiretroviral therapy according to the WHO recommendations on the survival of HIV-positive patients in Taiwan
Background/purpose: Early initiation of antiretroviral therapy (ART) reduces the risks for serious infections and mortality. We aimed to assess the outcomes of initiating ART among HIV-positive Taiwanese according to the CD4 cut-off values by the WHO recommendations. Methods: We reviewed medical rec...
| Main Authors: | , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2020-12-01
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| Series: | Journal of Microbiology, Immunology and Infection |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1684118219300428 |
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| author | Wang-Da Liu Wan-Chen Tsai Wei-Ting Hsu Ming-Chieh Shih Mao-Yuan Chen Hsin-Yun Sun Szu-Min Hsieh Wang-Huei Sheng Yu-Chung Chuang Aristine Cheng Kuan-Yin Lin Yu-Shan Huang Sung-Hsi Huang Yi-Chia Huang Guan-Jhou Chen Pei-Ying Wu Chien-Ching Hung Shan-Chwen Chang |
| author_facet | Wang-Da Liu Wan-Chen Tsai Wei-Ting Hsu Ming-Chieh Shih Mao-Yuan Chen Hsin-Yun Sun Szu-Min Hsieh Wang-Huei Sheng Yu-Chung Chuang Aristine Cheng Kuan-Yin Lin Yu-Shan Huang Sung-Hsi Huang Yi-Chia Huang Guan-Jhou Chen Pei-Ying Wu Chien-Ching Hung Shan-Chwen Chang |
| author_sort | Wang-Da Liu |
| collection | DOAJ |
| description | Background/purpose: Early initiation of antiretroviral therapy (ART) reduces the risks for serious infections and mortality. We aimed to assess the outcomes of initiating ART among HIV-positive Taiwanese according to the CD4 cut-off values by the WHO recommendations. Methods: We reviewed medical records of patients with newly diagnosed HIV infection between 2004 and 2015 and 3 groups of patients were defined according to the timing of ART initiation based on CD4 count recommended by WHO: Group 1 between 2004 and 2009; Group 2 between 2010 and 2012; and Group 3 between 2013 and 2015. The primary outcome was all-cause mortality. All patients were followed until 2 years after the last patient was included in each group. Results: Of 2022 patients included, the mortality rate was 18.28, 14.01, and 9.10 deaths per 1000 person-years of follow-up (PYFU) in Groups 1, 2, and 3, respectively. In multivariable Cox regression analysis, factors associated with mortality were age (per 1-year increase, adjusted hazard ratio [AHR], 1.06; 95% CI, 1.05–1.08), presence of AIDS-defining disease at HIV diagnosis (AHR, 4.81; 95% CI, 2.99–7.74), solid-organ malignancy (AHR, 3.10; 95% CI, 1.86–5.18), and initiation of ART (AHR, 0.09; 95% CI, 0.05–0.16). By competing risk regression model for non-AIDS-related death, the AHR for Group 3 versus Group 1 was 0.27 (95% CI, 0.09–0.80). Conclusions: While continued efforts are needed to improve early diagnosis and linkage to care, initiation of cART improved survival among HIV-positive patients in Taiwan according to the increasing CD4 cut-off values that were recommended by the WHO. |
| first_indexed | 2024-12-17T21:35:54Z |
| format | Article |
| id | doaj.art-d769bf45d0654e22809e00c24f0ced1d |
| institution | Directory Open Access Journal |
| issn | 1684-1182 |
| language | English |
| last_indexed | 2024-12-17T21:35:54Z |
| publishDate | 2020-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Microbiology, Immunology and Infection |
| spelling | doaj.art-d769bf45d0654e22809e00c24f0ced1d2022-12-21T21:31:45ZengElsevierJournal of Microbiology, Immunology and Infection1684-11822020-12-01536936945Impact of initiation of combination antiretroviral therapy according to the WHO recommendations on the survival of HIV-positive patients in TaiwanWang-Da Liu0Wan-Chen Tsai1Wei-Ting Hsu2Ming-Chieh Shih3Mao-Yuan Chen4Hsin-Yun Sun5Szu-Min Hsieh6Wang-Huei Sheng7Yu-Chung Chuang8Aristine Cheng9Kuan-Yin Lin10Yu-Shan Huang11Sung-Hsi Huang12Yi-Chia Huang13Guan-Jhou Chen14Pei-Ying Wu15Chien-Ching Hung16Shan-Chwen Chang17Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, TaiwanDepartment of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, TaiwanDepartment of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, TaiwanInstitute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Department of Medical Education, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, TaiwanDepartment of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, TaiwanDepartment of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, TaiwanDepartment of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, TaiwanDepartment of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Department of Medical Education, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, TaiwanDepartment of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, TaiwanDepartment of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, TaiwanDepartment of Medicine, National Taiwan University Hospital Jin-Shan Branch, New Taipei City, TaiwanDepartment of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, TaiwanDepartment of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan; Department of Tropical Medicine and Parasitology, National Taiwan University College of Medicine, Taipei, TaiwanDepartment of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, TaiwanDepartment of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin County, TaiwanCenter of Infection Control, National Taiwan University Hospital, Taipei, TaiwanDepartment of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Department of Tropical Medicine and Parasitology, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan; China Medical University, Taichung, Taiwan; Corresponding author. Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, 100, Taiwan. Fax: +886 2 23832172.Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, TaiwanBackground/purpose: Early initiation of antiretroviral therapy (ART) reduces the risks for serious infections and mortality. We aimed to assess the outcomes of initiating ART among HIV-positive Taiwanese according to the CD4 cut-off values by the WHO recommendations. Methods: We reviewed medical records of patients with newly diagnosed HIV infection between 2004 and 2015 and 3 groups of patients were defined according to the timing of ART initiation based on CD4 count recommended by WHO: Group 1 between 2004 and 2009; Group 2 between 2010 and 2012; and Group 3 between 2013 and 2015. The primary outcome was all-cause mortality. All patients were followed until 2 years after the last patient was included in each group. Results: Of 2022 patients included, the mortality rate was 18.28, 14.01, and 9.10 deaths per 1000 person-years of follow-up (PYFU) in Groups 1, 2, and 3, respectively. In multivariable Cox regression analysis, factors associated with mortality were age (per 1-year increase, adjusted hazard ratio [AHR], 1.06; 95% CI, 1.05–1.08), presence of AIDS-defining disease at HIV diagnosis (AHR, 4.81; 95% CI, 2.99–7.74), solid-organ malignancy (AHR, 3.10; 95% CI, 1.86–5.18), and initiation of ART (AHR, 0.09; 95% CI, 0.05–0.16). By competing risk regression model for non-AIDS-related death, the AHR for Group 3 versus Group 1 was 0.27 (95% CI, 0.09–0.80). Conclusions: While continued efforts are needed to improve early diagnosis and linkage to care, initiation of cART improved survival among HIV-positive patients in Taiwan according to the increasing CD4 cut-off values that were recommended by the WHO.http://www.sciencedirect.com/science/article/pii/S1684118219300428Treatment guidelinesMortalityOpportunistic illnessOpportunistic infectionCare cascade |
| spellingShingle | Wang-Da Liu Wan-Chen Tsai Wei-Ting Hsu Ming-Chieh Shih Mao-Yuan Chen Hsin-Yun Sun Szu-Min Hsieh Wang-Huei Sheng Yu-Chung Chuang Aristine Cheng Kuan-Yin Lin Yu-Shan Huang Sung-Hsi Huang Yi-Chia Huang Guan-Jhou Chen Pei-Ying Wu Chien-Ching Hung Shan-Chwen Chang Impact of initiation of combination antiretroviral therapy according to the WHO recommendations on the survival of HIV-positive patients in Taiwan Journal of Microbiology, Immunology and Infection Treatment guidelines Mortality Opportunistic illness Opportunistic infection Care cascade |
| title | Impact of initiation of combination antiretroviral therapy according to the WHO recommendations on the survival of HIV-positive patients in Taiwan |
| title_full | Impact of initiation of combination antiretroviral therapy according to the WHO recommendations on the survival of HIV-positive patients in Taiwan |
| title_fullStr | Impact of initiation of combination antiretroviral therapy according to the WHO recommendations on the survival of HIV-positive patients in Taiwan |
| title_full_unstemmed | Impact of initiation of combination antiretroviral therapy according to the WHO recommendations on the survival of HIV-positive patients in Taiwan |
| title_short | Impact of initiation of combination antiretroviral therapy according to the WHO recommendations on the survival of HIV-positive patients in Taiwan |
| title_sort | impact of initiation of combination antiretroviral therapy according to the who recommendations on the survival of hiv positive patients in taiwan |
| topic | Treatment guidelines Mortality Opportunistic illness Opportunistic infection Care cascade |
| url | http://www.sciencedirect.com/science/article/pii/S1684118219300428 |
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