Journal of Antivirals & Antiretrovirals
Open Access

Abstract

Effect of Viral Load and Drug Resistance on Mortality among Chinese HIV-Infected Patients Receiving Antiretroviral Treatment

Xia Wang, Hui Xing, Yuhua Ruan, Lingjie Liao, Haiwei Zhou, Bin Chen, Junqi Su, Wei Zheng and Yiming Shao

Background: The Chinese National Free Antiretroviral Treatment Program (NFATP) for HIV-infected patients has saved lives. However, there is no data on the effect of HIV drug resistance on mortality among Chinese patients receiving antiretroviral treatment. Methods: We linked patient records from two national databases: baseline HIV drug resistance and viral load data were obtained from four national drug resistance surveys in 2004, 2005, 2006 and 2009, and all-cause mortality was ascertained in a prospective way in NFATP database. Factors associated with death were identified by Cox regression model. Results: A total of 5421 HIV-infected patients who participated in the drug resistance surveys and received combination antiretroviral therapy (cART) from NFATP were included in the analysis. Approximately one-third of patients (1462/5421) had baseline plasma HIV-1 viral load ≥1,000 copies/ml, and 48.4% (708/1462) of these patients with virologic failure had resistance to any type of HIV drug. The mortality rate was 2.8 per 100 person-years in all participating patients, 4.8 in patients with virologic failure, and 5.7 in patients with drug resistance. Multivariate Cox regression analyses showed that older age, female, transmission through plasma/blood and drug injection, lower CD4 count, virologic failure and drug resistance, and didanosine-based regimens had statistically significant associations with increased risk of mortality. Conclusions: Virologic failure and drug resistance are common among Chinese HIV-infected patients receiving antiretroviral treatment. Virologic failure and drug resistance are associated with an increased risk of mortality. Treatment adherence should be promoted to reduce the risks of both virologic failure and drug resistance, and virologic and clinical monitoring of treatment should be enhanced to guide more appropriate use of cART drugs.