Shao Yiming

广西壮族自治区2008－2015年艾滋病病毒感染者基线CD 4 + T淋巴细胞计数水平对抗病毒治疗脱失的影响

Objective: To investigate the effect of baseline CD(4)(+) T cell count (CD(4)) on drop-out of antiretroviral therapy (ART) in HIV infected persons. Methods: Retrospective cohort was conducted in this study. HIV infected persons aged≥18 years and receiving free ART for the first time in Guangxi Zhuang Autonomous Region (Guangxi) from 2008 to 2015 were selected from the antiretroviral treatment database of National Comprehensive HIV/AIDS Information System, with follow-up conducted till May 30, 2016. Cause-specific Cox proportional hazard models were used to evaluate effect of different CD(4) on the drop-out of ART in the HIV infected persons. Results: A total of 58 502 eligible study participants were included in this retrospective cohort study. The average drop-out ratio was 4.8/100 person-years. After controlling the following baseline covariates: age, sex, marital status, route of HIV infection, WHO clinical stage before ART, initial/current ART regiment, ART regiment adjustment, and year of initiating ART for potential confounding, the adjusted HR of drop-out for HIV infected persons with 200- cells/μl, 351-cells/μl and ≥500 cells/μl were 1.110 (95%CI: 1.053-1.171, P<0.001), 1.391 (95%CI: 1.278-1.514, P<0.001) and 1.695 (95%CI: 1.497-1.918, P<0.001), respectively, in risk for drop-out compared with those with baseline CD(4)<200 cells/μl. Among the HIV infected persons, 56.0% (1 601/2 861) of drug withdrawal was due to poor compliance with medication. Conclusions: With the increase of baseline CD(4) when initiating ART, the risk for the drop-out in HIV infected persons increased significantly. To further reduce the drop-out of ART, it is important to take CD(4) into account in initiating ART and to strengthen the health education on treatment compliancy and training for healthcare providers.

Letter to the Editor: Risk Factors for Death in Subjects with Transfusion-Related HIV Infection in Rural China

95 Dear Editor: Disease progression of HIV infection is affected by both viral and host factors. Studies among people with transfusion-acquired HIV infection have shown that rapid death or disease progression in recipients may be associated with older age, male gender, poor health status at transfusion, more transfusions, and donor’s disease status.1–3 In China, unregulated paid plasma/blood donation practices in the early 1990s caused many HIV and other blood-borne infections in rural communities, and is the second largest contributor to the HIV/AIDS epidemic.4 The Chinese government began to take firm actions beginning in 1996 by shutting down illegal and unqualified collection stations, and creating new laws and regulations on blood collection such as the “Law of Blood Donation” in 1998 and the updated version of “Regulation on Blood Stations” in 2005. Since April 2004, the China CARE project has provided free antiretroviral therapy (ART) to these HIV-infected rural residents. We investigated the transfusion-related factors associated with mortality among ARTnaive individuals with HIV infection caused by blood transfusion in rural China. HIV testing laboratories or hospitals in China are required by law to report new HIV/AIDS cases to the local Center for Disease Control and Prevention (CDC). Staff from the local CDC contact infected individuals to collect demographic data, including HIV risk factors, and to provide information and education to reduce further transmission. Cases are then reported to the national China CDC. Study subjects for this analysis were identified from the HIV/AIDS reporting system in Yuncheng Prefecture, Shanxi Province, in central China. Study subjects were included if they had: (1) a single blood/plasma transfusion; (2) no cancer, heart disease, or anemia (potentially life-shortening diseases) at transfusion; and (3) no other identifiable high-risk HIV behaviors, such as injection drug use, commercial sex activity, or blood/plasma donation. Medical records were reviewed and transfusion data abstracted. Survival analyses were performed to assess the factors associated with death (SAS software, version 9.1, SAS Institute, Cary, NC). Data were censored on March 31, 2004. Blood specimens were collected for HIV-1 subtype analyses. The study protocol and informed consent were approved by the institutional review board of the