Long-term effect of antiretroviral therapy on mortality among HIV-positive children and adolescents in China

Hanxi Zhang; Xiaojie Lao; Huiqin Li; Hongyan Lu; Yuewu Cheng; Yuxia Song; Qingxia Zhao; Jinfeng Chen; Fuxiu Ye; Hongxin Zhao; Fujie Zhang

doi:10.1016/j.heliyon.2024.e27961

Long-term effect of antiretroviral therapy on mortality among HIV-positive children and adolescents in China

Heliyon. 2024 Mar 26;10(7):e27961. doi: 10.1016/j.heliyon.2024.e27961. eCollection 2024 Apr 15.

Authors

Hanxi Zhang^{1

2}, Xiaojie Lao^{2

3}, Huiqin Li⁴, Hongyan Lu⁵, Yuewu Cheng⁶, Yuxia Song⁷, Qingxia Zhao⁸, Jinfeng Chen⁹, Fuxiu Ye¹⁰, Hongxin Zhao^{2

3}, Fujie Zhang^{2

3}

Affiliations

¹ WHO Collaborating Centre for Comprehensive Management of HIV Treatment and Care, Beijing Ditan Hospital, Capital Medical University, Beijing, China.
² Department of HIV/AIDS, Beijing Ditan Hospital, Capital Medical University, Beijing, China.
³ Clinical Center for HIV/AIDS, Capital Medical University, Beijing, China.
⁴ AIDS Care Center, Yunnan Provincial Hospital of Infectious Disease, Kunming, China.
⁵ Department of Infectious Disease, Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, Nanning, China.
⁶ Department of Infectious Disease, Shangcai Center for Disease Control and Prevention of Henan Province, Shangcai, China.
⁷ The Sixth People's Hospital of Xinjiang Uygur Autonomous Region, The Xinjiang Uygur Autonomous Region, China.
⁸ Department of Infectious Disease, The Sixth People's Hospital of Zhengzhou, Zhengzhou, China.
⁹ Center for Infectious Diseases, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China.
¹⁰ Department of Infectious Disease, The Second People's Hospital of Yining, The Xinjiang Uygur Autonomous Region, China.

Abstract

Introduction: Highly active antiretroviral therapy (HAART) was piloted in 2002 and was scaled up in 2003 in mainland China. The aim of this study was to evaluate the mortality and its possible predictors based on the long-term initial antiretroviral therapy (ART) cohort among HIV positive children and adolescents.

Methods: This prospective open-labeled multicenter cohort study was conducted from January 2008 to July 2021. The participants were recruited from six representative sites in mainland China. A total of 609 participants with an HIV-positive serostatus and <18 years old were recruited and each participant was informed consent at the time of enrollment. Mortality and annual hazard were calculated, and predictors for death were analyzed using Cox regression models generating hazard ratios (HR).

Results: The results showed that the mortality was 0.721 per hundred person-years, and the annual hazard was less than 0.10 over time. Both CD4⁺T cell count and CD4⁺T cell percentage declined in the death group during the follow-up. The Cox regression model showed that the baseline low CD4⁺T cell count level (Low vs. High: aHR = 8.309, 95% CI: (1.093, 63.135)) and age >5 years old at HIV diagnosis (6-12 vs. 0-5: aHR = 3.140, 95%CI: (1.331, 27.411)); 13-18 vs. 0-5: aHR = 5.451, 95%CI: (1.434, 20.724)) were possible risk factors for death.

Conclusion: The longitudinal cohort study demonstrated the efficacy of China's ART program among HIV-positive children and adolescents which could be beneficial to other countries with limited resources.

Keywords: Adolescents; Children; Cohort study; HIV; Mortality.