Survival Analysis of Antiretroviral Treatment for PLWH in Sichuan Province, China, 2003-2022: A Large Retrospective Cohort Study

Abstract

Background: Sichuan Province was severely affected by the HIV, and there was a scarcity of data regarding the survival time and influencing factors for People Living with HIV/AIDS (PLWH) in Sichuan Province who have received Antiretroviral Therapy (ART). Therefore, it is necessary to conduct a survival analysis for PLWH receiving ART. Methods: A retrospective cohort study was conducted on PLWH who had received ART≥6 months in Sichuan Province from January 1, 2003, to December 31, 2022. The Kaplan-Meier method was used to calculate median survival time and plot survival curves, while a Cox proportional hazards regression model was applied to analyze factors affecting survival time. Bilateral tests were performed, with P≤0.05 considered statistically significant. Results: The cumulative survival rates at 1, 3, 5, and 10 years for the 223,386 subjects were 94.54%, 89.07%, 84.82%, and 76.44%, respectively. Multivariate analysis using the Cox regression model indicated lower mortality risks for females (HR=0.59, 95% CI: 0.54–0.65), homosexual transmission (HR=0.43, 95% CI: 0.33–0.55), and baseline BMI≥24 (HR=0.81, 95% CI: 0.72–0.90). Higher mortality risks were associated with age≥50 years at diagnosis (HR=3.21, 95% CI: 2.94–3.50), being unmarried or divorced (HR=1.23, 95% CI: 1.11–1.37), living separately (HR=1.32, 95% CI: 1.22–1.43), baseline BMI <18.5 (HR=1.27, 95% CI: 1.13–1.41), presence of single-drug resistance (HR=1.25, 95% CI: 1.15–1.36), baseline WHO stage IV (HR=1.27, 95% CI: 1.09–1.47), and a diagnosis-to-treatment interval >12 months (HR=1.27, 95% CI: 1.15–1.41). Compared to those with CD4(+) T cell count of 200–350cells/μL, 350– 500cells/μL, and >500cells/μL at baseline, individuals with <200cells/μL had higher mortality risks (HR=0.73, 95% CI: 0.67–0.79; HR=0.57, 95% CI: 0.51–0.64; and HR=0.58, 95% CI: 0.51–0.66, respectively). Conclusion: The survival rate for PLWH receiving ART in Sichuan Province was relatively high. Male gender, age over 50 at diagnosis, being unmarried, divorced, or living separately, presence of single-drug resistance, low baseline BMI, baseline CD4+ T cell <200cells/μL, baseline WHO stage IV, and a diagnosis-to-treatment interval >12 months were risk factors for the survival of PLWH.