BACKGROUND

The conventional survival analysis model on HIV/AIDS prognosis is the Cox proportional hazard model, which deals with only one event type, death, regardless of the cause. Few studies have used a competing risk model to evaluate the predictors of AIDS-related mortality.

OBJECTIVE

To estimate the influence of antiretroviral therapy (ART) initiation time and baseline CD4 cell counts on acquired immunodeficiency syndrome (AIDS)-related death among former plasma donors.

METHODS

A retrospective cohort study was conducted involving 11,905 human immunodeficiency virus (HIV) or AIDS patients in a high-risk area of Henan province in China between 1995 and 2016. Demographic and clinical data were collected. Sub-distribution hazard ratios () for AIDS-related mortality with baseline CD4 cell counts and ART initiation time were determined using a competing risk model.

RESULTS

Patients who initiated ART within 90 days of HIV/AIDS diagnosis (: 0.24, 95% : 0.22-0.27) or had baseline CD4 counts of >500 cells/μL (: 0.23, 95% : 0.19-0.28) were associated with lower AIDS-related mortality risk. Patients with ART initiation time >1 year but CD4 counts >350 cells/μL (: 4.42, 95% : 3.30-5.91) had a higher AIDS-related mortality risk than those with ART initiation time >90 days but CD4 counts ≤350 cells/μL (: 4.33, 95% : 3.58-5.23).

CONCLUSIONS

Our results demonstrate that patients with high CD4 cell counts and late ART had a 9% higher risk of AIDS-related death than those with low CD4 cell counts and early ART. This study confirms the great significance of immediate ART initiation among former plasma donor HIV patients in China.