The effect of highly active antiretroviral therapy on mortality among HIV-infected former plasma donors in China

Abstract

Background. In China, many former plasma donors were infected with the human immunodeficiency virus (HIV) in the early-mid-1990s. Highly active antiretroviral therapy (HAART) was provided for former plasma donors beginning in 2002. The effect of HAART on mortality in this cohort has not been described. Methods. This study is a retrospective analysis of the national HIV epidemiology and treatment databases for the period 1993-2006. All HIV-infected subjects from 10 counties with a high prevalence of HIV infection in 6 provinces were eligible. Inclusion criteria were: (1) history of plasma donation, (2) positive Western blot result, (3) clinical diagnosis of AIDS or CD4+ cell count <200 cells/μL at any time, and (4) age ≥18 years at AIDS diagnosis. Results. Of 9059 eligible subjects, 4093 met the inclusion criteria. Mean age was 41 years, 51% were male, 99% were farmers, and 87% were from Henan Province. Overall mortality decreased from 27.3 deaths per 100 person-years in 2001 to 4.6 deaths per 100 person-years in 2006. Conversely, the percentage of patient-years receiving HAART increased from 0% in 2001 to 70.5% in 2006. In a multivariate Cox proportional hazards analysis, not receiving HAART was the greatest risk factor for mortality (hazard ratio, 2.8; 95% confidence interval, 2.4-3.3). Among treated patients, those who had lower CD4+ cell counts and higher numbers of opportunistic infections at the initiation of therapy were at greater risk of death. Conclusions. The national treatment program has significantly reduced the mortality rate among HIV-infected former plasma donors through the use of generic drugs in a rural treatment setting with limited laboratory monitoring. Treatment success can be improved through increased coverage and earlier initiation of therapy. © 2008 by the Infectious Diseases Society of America. All rights reserved.