The burden of serious non-AIDS-defining events among admitted cART-naive AIDS patients in China: An observational cohort study

PLoS One. 2020 Dec 22;15(12):e0243773. doi: 10.1371/journal.pone.0243773. eCollection 2020.

Abstract

The objective of this study was to elucidate the burden, risk factors, and prognosis of serious non-AIDS-defining events among admitted cART-naive AIDS patients in China. The evaluation of the burden, risk factors and prognosis of serious NADEs was carried out among 1309 cART-naive AIDS patients (median age: 38.2 years, range: 18-78 years) admitted in Beijing Ditan Hospital between January 2009 and December 2018. Among 1309 patients, 143 patients (10.9%) had at least one serious NADEs, including 49 (3.8%) with cerebrovascular diseases, 37 (2.8%) with non-AIDS-defining cancers, 28 (2.1%) with chronic kidney diseases, 26 (2.0%) with cardiovascular diseases, and 18 (1.4%) with liver cirrhosis. Serious NADEs distributed in different age and CD4 levels, especially with age ≥50 years and CD4 ≤350 cells/ul. Other traditional risk factors, including cigarette smoking (OR = 1.9, 95%CI = 1.3-2.8, p = 0.002), hypertension (OR = 2.5, 95%CI = 1.7-3.7, p<0.001), chronic HCV infection (OR = 2.8, 95%CI = 1.4-5.6, p = 0.004), and hypercholesterolemia (OR = 4.1, 95% CI = 1.2-14.1, p = 0.026), were also associated with serious NADEs. Seventeen cases (1.3%) with serious NADEs died among hospitalized cART-naive AIDS patients, and severe pneumonia (HR = 5.5, 95%CI = 1.9-15.9, p<0.001) and AIDS-defining cancers (HR = 3.8, 95%CI = 1.1-13.2, p = 0.038) were identified as risk factors associated with an increased hazard of mortality among these patients with serious NADEs. Serious NADEs also occurred in cART-naive AIDS patients in China with low prevalence. Our results reminded physicians that early screening of serious NADEs, timely intervention of their risk factors, management of severe AIDS-defining events, multi-disciplinary cooperation, and early initiation of cART were essential to reduce the burden of serious NADEs.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acquired Immunodeficiency Syndrome / diagnosis
  • Acquired Immunodeficiency Syndrome / drug therapy
  • Acquired Immunodeficiency Syndrome / epidemiology*
  • Acquired Immunodeficiency Syndrome / immunology
  • Age Distribution
  • Aged
  • Anti-HIV Agents / therapeutic use
  • CD4 Lymphocyte Count
  • China / epidemiology
  • Cohort Studies
  • Cost of Illness*
  • Drug Interactions
  • Female
  • Humans
  • Male
  • Middle Aged
  • Prognosis

Substances

  • Anti-HIV Agents

Grants and funding

We acknowledge the work of HIV health care providers for their diagnosis, nursing and treatment of HIV/AIDS patients in Ditan Hospital. Support for this work was provided by: (1) The National Key Project Prevention and Therapy of Fatal Infectious Diseases such AIDS & Viral Hepatitis: Popularization and application of diagnosis and treatment of Belt and Road HIV/AIDS with Traditional Chinese Medicine (grant 2018ZX10101001-005-001); (2) The National Key Project-- the Development of New Pharmaceuticals: the Construction of Platform for Clinical Evaluation of New Antiretroviral Therapy--Clinical trial phase I-IV. (grant 2017ZX09304027-001-010); (3) The Thirteen-fifth Key Project The Study of Construction of Representative areas for Prevention and Therapy of Fatal Infectious Diseases such AIDS & Viral Hepatitis in Chaoyang District, Beijing (grant 2018ZX10715-005); (4) the National natural Science Fund the Study for Delay and Persistent Poor Immune Reconstitution in HIV/AIDS patients (grant 81672000); (5) Project from Beijing Municipal Committee of Science & Technology The study of HIV/HBV co-infection (grant D161100000416004). (6) Project for Capital Characteristics The study for blood concentration of efavirenz influenced by rifampin in HIV/TB co-infected patient (grantZ171100001017053). (7) the Program for the 13th Five-year Plan of China The study of non-AIDS-defining events among HIV-infected population long-term receiving ART (2017ZX10202101004); (8) The Key project from Beijing Hospital Authority (DFL20191802). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.