Last data update: May 13, 2024. (Total: 46773 publications since 2009)
Records 1-6 (of 6 Records) |
Query Trace: Chen RY[original query] |
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Five-year outcomes of the China National Free Antiretroviral Treatment Program
Zhang F , Dou Z , Ma Y , Zhao Y , Liu Z , Bulterys M , Chen RY . Ann Intern Med 2009 151 (4) I-42 BACKGROUND: China's National Free Antiretroviral Treatment Program began in 2002 and, by August 2008, included over 52,000 patients. OBJECTIVE: To report five year outcomes on adult mortality and immunological treatment failure rates and risk factors. DESIGN: Open cohort analysis of prospectively collected observational database. PATIENTS: All patients in national treatment database from June 2002-August 2008. Patients excluded if not started on triple therapy or had missing treatment regimen information. INTERVENTION: Antiretroviral therapy per Chinese national treatment guidelines. MEASUREMENTS: Mortality rate and immunologic treatment failure rate using World Health Organization criteria. RESULTS: Of 52,191 total patients, 48,785 were included. Median age was 38 years, 58% were male, 53% were infected through plasma/blood, and median baseline CD4 cell count was 118/μL. Mortality was greatest during the first three months of treatment (22.6/100 person-years) but declined to a steady rate of 4-5/100 person-years after six months and maintained over the subsequent 4½ years. Baseline CD4 cell count <50/μL (adjusted hazard ratio [HR] 3.3, 95% confidence interval [CI] 2.9-3.8, compared to ≥200/μL) and having 4-5 baseline symptom categories (adjusted HR 3.4, 95% CI 2.9-4.0, compared to no baseline symptoms) were the strongest mortality risk factors. Treatment failure was determined among 31,070 with ≥1 follow-up CD4 cell count. Overall, 25% (12.0/100 person-years) failed treatment with the cumulative treatment failure rate increasing to 50% at five years. LIMITATION: Immunologic treatment failure does not necessarily correlate well with virologic treatment failure. CONCLUSIONS: The National Free Antiretroviral Treatment Program reduced mortality among adult AIDS patients in China to rates comparable to other low or middle-income countries. A cumulative immunological treatment failure rate of 50% after five years, with limited availability of second-line regimens, is of great concern. |
Factors associated with survival among adults with HIV-associated TB in Guangxi, China: a retrospective cohort study
Zhang Y , Sun K , Yu L , Tang Z , Huang S , Meng Z , Zheng Y , Wen Y , Zhu H , Chen RY , Varma JK , Zhang F . Future Virol 2012 7 (9) 933-942 AIM: Although China has the second highest burden of TB in the world and faces a burgeoning HIV epidemic, the epidemiology and 12-month clinical outcomes of HIV-infected TB patients have not previously been reported. METHODS: We reviewed records of all HIV-infected adults diagnosed with culture-confirmed TB from four HIV clinics in Guangxi, China from August 2006 to December 2008. Factors associated with patients survival within 12 months after TB diagnosis were evaluated in Cox proportional hazards models. RESULTS: Among the 201 patients included, 47 (23%) died within 12 months. Median CD4 count at TB diagnosis was 37 cells/mm(3) (interquartile range: 16-102). Receiving HAART (adjusted hazard ratio [AHR]: 4.2; 95% CI: 1.6-10.8), receiving TB treatment (AHR: 9.0; 95% CI: 1.5-53.5) and baseline BMI ≥ 18.5 (AHR: 8.4; 95% CI: 1.9-35.8) were independently associated with survival. Among 171 (85%) patients who received TB treatment, receiving HAART (HR: 5.1; 95% CI: 2.4-10.7) was the only factor significantly associated with survival. CONCLUSION: HIV-infected Chinese patients diagnosed with TB in Guangxi are at high risk of death within 12 months, a risk that is strongly mitigated by antiretroviral therapy. Improving survival from HIV-associated TB in China will require the integration of TB and HIV programs to improve access to treatment for both diseases. (2012 Future Medicine Ltd.) |
Association between missed early visits and mortality among patients of China National Free Antiretroviral Treatment cohort
Zhang Y , Dou Z , Sun K , Ma Y , Chen RY , Bulterys M , Zhao Y , Zhu H , Liu Z , Zhang F . J Acquir Immune Defic Syndr 2012 60 (1) 59-67 BACKGROUND: China's National Free Antiretroviral Treatment program has scaled-up rapidly since 2002, leading to a significant reduction of mortality among its participants. However, few studies have evaluated indicators for patient access to medical care and their association with mortality. METHODS: Patients enrolled into this national program between June 2002 and June 2009 for at least 7.5 months were retrospectively analyzed. RESULTS: Twenty-seven thousand five hundred four patients were included into the analysis, among whom 10,034 (37%) had at least 1 missed visit during the first 6 months of treatment. In Cox proportional hazard regression analysis, controlled for baseline demographic and clinical factors, patients with more missed visits had a higher risk of mortality, with an adjusted hazard ratio of 1.3 (95% confidence interval: 1.1 to 1.5) for 1-2 missed visits and 1.7 (95% confidence interval 1.4 to 2.2) for ≥3 missed visits compared with patients with no missed visits. In multivariate logistic regression models, factors independently associated with a higher likelihood of early missed visits included female gender, age >60, HIV transmission via injection drug use or via plasma donation compared with sexual transmission, baseline alanine aminotransferase >100 IU/L, having more symptoms at antiretroviral therapy initiation and receiving a didanosine-based regimen compared with lamivudine-based regimen. Lower baseline CD4 count was protective against missed visits. CONCLUSIONS: Missing early visits occurred in a sizable number of patients in this cohort and was associated with a higher mortality rate. Early missed visits may serve as an early warning indicator to trigger additional outreach effort. |
Effect of earlier initiation of antiretroviral treatment and increased treatment coverage on HIV-related mortality in China: a national observational cohort study
Zhang F , Dou Z , Ma Y , Zhang Y , Zhao Y , Zhao D , Zhou S , Bulterys M , Zhu H , Chen RY . Lancet Infect Dis 2011 11 (7) 516-24 BACKGROUND: Overall HIV mortality rates in China have not been reported. In this analysis we assess overall mortality in treatment-eligible adults with HIV and attempt to identify risk factors for HIV-related mortality. METHODS: We used data from the national HIV epidemiology and treatment databases to identify individuals aged 15 years or older with HIV who were eligible for highly active antiretroviral therapy between 1985 and 2009. Mortality rates were calculated in terms of person-years, with risk factors determined by Cox proportional hazard regression. Treatment coverage was calculated as the proportion of time that patients who were eligible for treatment received treatment, with risk factors for not receiving treatment identified by use of logistic regression. FINDINGS: Of 323 252 people reported as having HIV in China by the end of 2009, 145 484 (45%) were identified as treatment-eligible and included in this analysis. Median CD4 count was 201 cells per muL (IQR 71-315) at HIV diagnosis and 194 cells per muL (73-293) when first declared eligible for treatment. Overall mortality decreased from 39.3 per 100 person-years in 2002 to 14.2 per 100 person-years in 2009, with treatment coverage concomitantly increasing from almost zero to 63.4%. By 2009, mortality was higher and treatment coverage lower in injecting drug users (15.9 deaths per 100 person-years; 42.7% coverage) and those infected sexually (17.5 deaths per 100 person-years; 61.7% coverage), compared with those infected through plasma donation or blood transfusion (6.7 deaths per 100 person-years; 80.2% coverage). The two strongest risk factors for HIV-related mortality were not receiving highly active antiretroviral therapy (adjusted hazard ratio 4.35, 95% CI 4.10-4.62) and having a CD4 count of less than 50 cells per muL when first declared eligible for treatment (7.92, 7.33-8.57). INTERPRETATION: An urgent need exists for earlier HIV diagnosis and better access to treatment for injecting drug users and patients infected with HIV sexually, especially before they become severely immunosuppressed. FUNDING: The National Centre for AIDS/STD Control and Prevention of the Chinese Centre for Disease Control and Prevention. |
Five-year outcomes of the China National Free Antiretroviral Treatment Program
Zhang F , Dou Z , Ma Y , Zhao Y , Liu Z , Bulterys M , Chen RY . Ann Intern Med 2009 151 (4) 241-51, W-52 BACKGROUND: China's National Free Antiretroviral Treatment Program began in 2002 and, by August 2008, included more than 52 000 patients. OBJECTIVE: To report 5-year outcomes on adult mortality and immunologic treatment failure rates and risk factors. DESIGN: Open cohort analysis of a prospectively collected, observational database. SETTING: China. PATIENTS: 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. INTERVENTION: Antiretroviral therapy according to Chinese national treatment guidelines. MEASUREMENTS: Mortality rate and immunologic treatment failure rate, according to World Health Organization criteria. RESULTS: 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. Limitation: Immunologic treatment failure does not necessarily correlate well with virologic treatment failure. CONCLUSION: 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. |
A public health approach to rapid scale-up of free antiretroviral treatment in China: an ounce of prevention is worth a pound of cure
Bulterys M , Vermund SH , Chen RY , Ou CY . Chin Med J (Engl) 2009 122 (11) 1352-5 China's rapidly evolving HIV/AIDS epidemic calls for a dramatic expansion of both prevention and treatment services.1,2 Official state media recently reported that for the first time, in 2008, HIV/AIDS became China's leading cause of death among infectious diseases.3 Estimates from the Ministry of Health indicate that around 700 000 people were living with HIV and 85 000 people had AIDS in 2007.4 Initially, HIV-1 infection was confined primarily to certain high-risk populations such as injection drug users (IDU) along drug-trafficking routes, and former plasma donors (FPD) in rural communities in east-central China.1,5–7 Now, however, HIV prevalence is increasing among female sex workers (FSW) and men who have sex with men (MSM).4,8 It is estimated that in 2008, approximately 45% of new HIV cases in China were attributed to heterosexual transmission and 12% to MSM; the proportion of women infected has also doubled in the past decade. | To respond effectively to the urgent need of patients with advanced HIV disease, the Chinese government in 2003 started the National Free Antiretroviral Treatment Program (NFATP). Initially focused on FPD in rural communities,6 this program has since expanded to all 31 provinces. In 2009, the government announced that second-line antiretroviral treatment (ART) — at a cost of approximately $1760 per patient per year — will be provided free to AIDS patients who have become resistant to first-line ART.9 In this issue of the Chinese Medical Journal, investigators and leaders from the National Center for AIDS/STD Control and Prevention (NCAIDS) at the Chinese Center for Disease Control and Prevention describe the formidable challenges in rolling out ART to all those who need it.10 They highlight ethical considerations in distributing the benefits of ART equitably in the context of seeking to minimize development of multi-drug resistant HIV strains. The authors conclude that the aim of universal access to ART is achievable in China with additional and innovative strategies. |
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