Effect of antiretroviral therapy initiation time and baseline CD4(+) cell counts on AIDS-related mortality among former plasma donors in China: a 21-year retrospective cohort study

BACKGROUND: The conventional survival analysis model on HIV/AIDS prognosis is the Cox proportional hazard model, which deals with only one event type, death, regardless of the cause. Few studies have used a competing risk model to evaluate the predictors of AIDS-related mortality. OBJECTIVE: To estimate the influence of antiretroviral therapy (ART) initiation time and baseline CD4(+) cell counts on acquired immunodeficiency syndrome (AIDS)-related death among former plasma donors. METHODS: A retrospective cohort study was conducted involving 11,905 human immunodeficiency virus (HIV) or AIDS patients in a high-risk area of Henan province in China between 1995 and 2016. Demographic and clinical data were collected. Sub-distribution hazard ratios (sHRs) for AIDS-related mortality with baseline CD4(+) cell counts and ART initiation time were determined using a competing risk model. RESULTS: Patients who initiated ART within 90 days of HIV/AIDS diagnosis (sHR: 0.24, 95% CI: 0.22–0.27) or had baseline CD4(+) counts of >500 cells/μL (sHR: 0.23, 95% CI: 0.19–0.28) were associated with lower AIDS-related mortality risk. Patients with ART initiation time >1 year but CD4(+) counts >350 cells/μL (sHR: 4.42, 95% CI: 3.30–5.91) had a higher AIDS-related mortality risk than those with ART initiation time >90 days but CD4(+) counts ≤350 cells/μL (sHR: 4.33, 95% CI: 3.58–5.23). CONCLUSIONS: Our results demonstrate that patients with high CD4(+) cell counts and late ART had a 9% higher risk of AIDS-related death than those with low CD4(+) cell counts and early ART. This study confirms the great significance of immediate ART initiation among former plasma donor HIV patients in China.