Yonsei Med J.  2020 Aug;61(8):705-711. 10.3349/ymj.2020.61.8.705.

Survival Trend of HIV/AIDS Patients Starting Antiretroviral Therapy in South Korea between 2001 and 2015

Affiliations
  • 1Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
  • 2Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
  • 3AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
  • 4Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
  • 5Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
  • 6Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
  • 7Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
  • 8Division of Viral Disease Research, Center for Infectious Disease Research, Korea National Institute of Health, Cheongju, Korea
  • 9Institute for Health and Society, Hanyang University, Seoul, Korea
  • 10Department of Preventive Medicine, Hanyang University College of Medicine, Seoul, Korea
  • 11Division of Infectious Disease, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea

Abstract

Purpose
In the recent antiretroviral therapy (ART) era, a large proportion of Korean patients with human immunodeficiency virus (HIV) infection were shown to have low CD4 cell counts at diagnosis and during ART initiation. We investigated the survival trends in patients living with HIV/acquired immunodeficiency syndrome (AIDS) in Korea who started ART in the 2000s, and evaluated the risk factors for mortality to elucidate the association between survival and low CD4 cell counts at ART initiation.
Materials and Methods
Patients with HIV infection who were aged >18 years and had started ART between 2001 and 2015 in the Korean HIV/AIDS cohort study were enrolled. We compared the clinical characteristics, mortality, and causes of death among the enrolled subjects based on the time of ART initiation. Cox regression analysis was used to estimate the adjusted hazard ratios of mortality based on the time of ART initiation.
Results
Among the 2474 patients enrolled, 105 (4.24%) died during the follow-up period of 9568 patient-years. Although CD4 cell counts at the time of ART initiation significantly increased from 161 [interquartile range (IQR), 73.5–303] in 2001–2003 to 273 (IQR, 108–399) in 2013–2015 (p<0.001), they remained low during the study period. The incidence of all-cause mortality was 10.97 per 1000 patient-years during the study period. There was no decreasing trend in mortality between 2001 and 2015. Age >40 years [adjusted hazard ratio, 3.71; 95% confidence interval (CI), 2.35–5.84] and low CD4 counts (<100 cells/mm3: adjusted hazard ratio, 2.99; 95% CI, 1.44–6.23) were significant risk factors for mortality.
Conclusion
Despite excellent HIV care available in the recent ART era, the survival of patients with HIV/AIDS undergoing ART did not improve between 2001 and 2015 in Korea.

Keyword

Anti-retroviral agents; HIV; Republic of Korea; survival
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