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      Immunological and virologic outcomes of people living with HIV in Guangxi, China: 2012-2017

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          Abstract

          Background

          Limited data are available on clinical outcomes of people living with HIV (PLWH) in China, especially after the implementation of the 2016 national treatment guideline. The objective of the current study is to examine the treatment patterns, clinical outcomes and their associated factors among PLWH in Guangxi, China before and after this new guideline.

          Methods

          Data from three community-based projects conducted at different time points over a period of six years (2012–2017) in Guangxi were analyzed in our study. The interviewer-administered questionnaire was used for data collection. Measures of clinical outcomes were retrieved from the patients’ medical records. Descriptive analysis was employed to display treatment patterns and the time trends of clinical outcomes. Chi-square test or ANOVA was used to compare the differences in background characteristics and treatment history between different levels of clinical outcomes.

          Results

          Among the pooled sample of 4224 participants, 77.3% were receiving antiretroviral therapy (ART), the median CD4 count was 328 cells/mm 3, and 82.5% were virally suppressed. An increasing trend in both ART coverage (from 72.1% to 91.2%) and CD4 count (from 318 cells/mm 3 to 357 cells/mm 3) was observed over time in the three samples, while rates of viral suppression did not show a similar trend. A number of socio-demographic characteristics (e.g., female gender, younger age, Han ethnicity, and employment) and treatment-related variables (e.g., longer durations of HIV diagnosis and ART uptake, lower prevalence of comorbidity, fewer treatment interruptions, and more knowledge on ART) were associated with improved clinical outcomes.

          Conclusions

          We observed a high rate of viral suppression and increasing trends in ART coverage and CD4 count over six years in Guangxi, China. However, suboptimal clinical outcomes continue to be a problem, particularly among some subgroups of PLWH. Future clinical management strategies should be tailored for PLWH with different sociodemographic characteristics and treatment trajectories.

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          Most cited references28

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          Framing Mechanisms Linking HIV-Related Stigma, Adherence to Treatment, and Health Outcomes.

          Bulent Turan, Abigail Hatcher, Sheri D Weiser … (2017)
          We present a conceptual framework that highlights how unique dimensions of individual-level HIV-related stigma (perceived community stigma, experienced stigma, internalized stigma, and anticipated stigma) might differently affect the health of those living with HIV. HIV-related stigma is recognized as a barrier to both HIV prevention and engagement in HIV care, but little is known about the mechanisms through which stigma leads to worse health behaviors or outcomes. Our conceptual framework posits that, in the context of intersectional and structural stigmas, individual-level dimensions of HIV-related stigma operate through interpersonal factors, mental health, psychological resources, and biological stress pathways. A conceptual framework that encompasses recent advances in stigma science can inform future research and interventions aiming to address stigma as a driver of HIV-related health.
          Article 0 comments Cited 120 times – based on 0 reviews     Review now
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            Five-year outcomes of the China National Free Antiretroviral Treatment Program.

            Fujie Zhang, Zhihui Dou, Ye Ma … (2009)
            China's National Free Antiretroviral Treatment Program began in 2002 and, by August 2008, included more than 52 000 patients. To report 5-year outcomes on adult mortality and immunologic treatment failure rates and risk factors. Open cohort analysis of a prospectively collected, observational database. China. All patients in the national treatment database from June 2002 to August 2008. Patients were excluded if they had not started triple therapy or had missing treatment regimen information. Antiretroviral therapy according to Chinese national treatment guidelines. Mortality rate and immunologic treatment failure rate, according to World Health Organization criteria. Of 52 191 patients, 48 785 were included. Median age was 38 years, 58% were men, 53% were infected through plasma or blood, and the median baseline CD4 cell count was 0.118x10(9) cells/L. Mortality was greatest during the first 3 months of treatment (22.6 deaths per 100 person-years) but decreased to a steady rate of 4 to 5 deaths per 100 person-years after 6 months and maintained this rate over the subsequent 4.5 years. The strongest mortality risk factors were a baseline CD4 cell count less than 0.050x10(9) cells/L (adjusted hazard ratio [HR] compared with a count>or=0.200x10(9) cells/L, 3.3 [95% CI, 2.9 to 3.8]) and having 4 to 5 baseline symptom categories (adjusted HR compared with no baseline symptom categories, 3.4 [CI, 2.9 to 4.0]). Treatment failure was determined among 31 070 patients with 1 or more follow-up CD4 cell counts. Overall, treatment failed for 25% of patients (12.0 treatment failures per 100 person-years), with the cumulative treatment failure rate increasing to 50% at 5 years. Immunologic treatment failure does not necessarily correlate well with virologic treatment failure. The National Free Antiretroviral Treatment Program reduced mortality among adult patients in China with AIDS to rates similar to those of other low- or middle-income countries. A cumulative immunologic treatment failure rate of 50% after 5 years, due to the limited availability of second-line regimens, is of great concern.
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              Development of antiretroviral drug resistance.

              M Wainberg, Gerasimos J Zaharatos, Michael B Brenner (2011)
              Article 0 comments Cited 67 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Xueying Yang:
                ORCID: http://orcid.org/0000-0001-6788-0688
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: MethodologyRole: Writing – original draftRole: Writing – review & editing
                Xiaoming Li: Role: ConceptualizationRole: ResourcesRole: Writing – review & editing
                Shan Qiao: Role: ConceptualizationRole: Project administration
                Quan Zhang: Role: Data curationRole: Methodology
                Zhiyong Shen: Role: Data curationRole: Investigation
                Yuejiao Zhou: Role: Resources
                Bharat S. Parekh: Role: Editor
                Journal
                Journal ID (nlm-ta): PLoS One
                Journal ID (iso-abbrev): PLoS ONE
                Journal ID (publisher-id): plos
                Journal ID (pmc): plosone
                Title: PLoS ONE
                Publisher: Public Library of Science (San Francisco, CA USA )
                ISSN (Electronic): 1932-6203
                Publication date (Electronic): 1 March 2019
                Publication date Collection: 2019
                Volume: 14
                Issue: 3
                Electronic Location Identifier: e0213205
                Affiliations
                [1 ] Department of Health Promotion, Education, and Behavior, South Carolina SmartState Center for Healthcare Quality (CHQ), Arnold School of Public Health, University of South Carolina, Columbia, SC, United States of America
                [2 ] Guangxi Center for Disease Control and Prevention, Nanning, Guangxi, People’s Republic of China
                Centers for Disease Control and Prevention, UNITED STATES
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                http://orcid.org/0000-0001-6788-0688
                Article
                Publisher ID: PONE-D-18-31223
                DOI: 10.1371/journal.pone.0213205
                PMC ID: 6396913
                PubMed ID: 30822343
                SO-VID: 6147c358-7710-4b91-a773-f4516bae6bce
                Copyright © © 2019 Yang et al
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date received : 29 October 2018
                Date accepted : 16 February 2019
                Page count
                Figures: 0, Tables: 3, Pages: 14
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/100000009, Foundation for the National Institutes of Health;
                Award ID: R01HD074221
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/501100001809, National Natural Science Foundation of China;
                Award ID: 71673146
                Award Recipient :
                The study was supported by National Institutes of Health (NIH; grant numbers R01HD074221 and MH0112376) and National Nature Science Foundation of China (NSFC; grant number 71673146). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Subject: Research Article
                Subject: Medicine and health sciences
                Subject: Diagnostic medicine
                Subject: HIV diagnosis and management
                Subject: Biology and Life Sciences
                Subject: Immunology
                Subject: Vaccination and Immunization
                Subject: Antiviral Therapy
                Subject: Antiretroviral Therapy
                Subject: Medicine and Health Sciences
                Subject: Immunology
                Subject: Vaccination and Immunization
                Subject: Antiviral Therapy
                Subject: Antiretroviral Therapy
                Subject: Medicine and Health Sciences
                Subject: Public and Occupational Health
                Subject: Preventive Medicine
                Subject: Vaccination and Immunization
                Subject: Antiviral Therapy
                Subject: Antiretroviral Therapy
                Subject: Biology and Life Sciences
                Subject: Microbiology
                Subject: Medical Microbiology
                Subject: Microbial Pathogens
                Subject: Viral Pathogens
                Subject: Immunodeficiency Viruses
                Subject: HIV
                Subject: Medicine and Health Sciences
                Subject: Pathology and Laboratory Medicine
                Subject: Pathogens
                Subject: Microbial Pathogens
                Subject: Viral Pathogens
                Subject: Immunodeficiency Viruses
                Subject: HIV
                Subject: Biology and Life Sciences
                Subject: Organisms
                Subject: Viruses
                Subject: Viral Pathogens
                Subject: Immunodeficiency Viruses
                Subject: HIV
                Subject: Biology and Life Sciences
                Subject: Organisms
                Subject: Viruses
                Subject: Immunodeficiency Viruses
                Subject: HIV
                Subject: Biology and life sciences
                Subject: Organisms
                Subject: Viruses
                Subject: RNA viruses
                Subject: Retroviruses
                Subject: Lentivirus
                Subject: HIV
                Subject: Biology and Life Sciences
                Subject: Microbiology
                Subject: Medical Microbiology
                Subject: Microbial Pathogens
                Subject: Viral Pathogens
                Subject: Retroviruses
                Subject: Lentivirus
                Subject: HIV
                Subject: Medicine and Health Sciences
                Subject: Pathology and Laboratory Medicine
                Subject: Pathogens
                Subject: Microbial Pathogens
                Subject: Viral Pathogens
                Subject: Retroviruses
                Subject: Lentivirus
                Subject: HIV
                Subject: Biology and Life Sciences
                Subject: Organisms
                Subject: Viruses
                Subject: Viral Pathogens
                Subject: Retroviruses
                Subject: Lentivirus
                Subject: HIV
                Subject: People and Places
                Subject: Geographical Locations
                Subject: Asia
                Subject: China
                Subject: Biology and Life Sciences
                Subject: Microbiology
                Subject: Virology
                Subject: Viral Transmission and Infection
                Subject: Viral Load
                Subject: Medicine and Health Sciences
                Subject: Health Care
                Subject: Health Care Policy
                Subject: Treatment Guidelines
                Subject: Medicine and health sciences
                Subject: Epidemiology
                Subject: HIV epidemiology
                Subject: Biology and Life Sciences
                Subject: Physiology
                Subject: Reproductive Physiology
                Subject: Copulation
                Subject: Medicine and Health Sciences
                Subject: Physiology
                Subject: Reproductive Physiology
                Subject: Copulation
                Custom metadata
                Data Availability Data cannot be shared publicly because of the data may compromise the privacy of study participants. The restrictions from the ethical application with the Wayne State University IRB prohibit the authors from making the minimal data set publicly available. Data are available upon request to the IRB at irbstatus@ 123456wayne.edu (IRB No. 052112B3F).

                ScienceOpen disciplines: Uncategorized
                Data availability:
                ScienceOpen disciplines: Uncategorized

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