Survival and risk factors associated with mortality in people living with HIV from 2005 to 2018 in Nanjing, China

Background: Although the introduction of antiretroviral therapy (ART) decreased the mortality of people living with Human Immunodeficiency Virus (PLHIV), substantially, hundreds of thousands of people are dying of AIDS each year. The accurate survival patterns and factors related to death among PLHIV were rarely reported. In this study, we evaluated survival status and identified factors associated with death among PLHIV in Nanjing. Methods: We conducted a retrospective analysis of PLHIV followed-up in Nanjing and registered to the national HIV/AIDS comprehensive management information system from 2005 to 2018. We used the life table to calculate the cumulative survival rates. We applied the Kaplan-Meier to calculate median survival times and employed cox hazard proportional regression to analyze the associated factors related to death. Results: The median survival time of PLHIV was 11.8 (95%CI:11.6-11.9) years from 2005 to 2018. Among 4,235 PLHIV included in this study, 7.5% had died of AIDS-related disease and the AIDS-related mortality rate was 2.0/100 PYs. The cumulative proportion surviving at the end of the interval was 95.2% over the 1st year, 94.0% over the 2nd year, 91.8% over the 5th year, and 85.4% over the 10th year, respectively. PLHIV who unaccepted ART showed a greater risk of death compared to those who accepted ART (AHR = 16.2, 95%CI:11.9 similar to 22.2). For baseline CD4 count, compared to CD4 < 200 cell/mu L, higher CD4 count was demonstrated as a protective factor, with AHR = 0.2 (95%CI: 0.1 similar to 0.3) for >= 500 cell/mu L AHR = 0.3 (95%CI:0.2 similar to 0.4) for 350 similar to 499 cell mu L, AHR = 0.4 (95%CI:0.3 similar to 0.6 for 200 similar to 349 cell/mu L). In addition, we observed a higher death risk in PLHIV who were screened through outpatient (AHR = 1.6, 95%CI: 1.1 similar to 2.2) and inpatient (AHR = 1.6, 95%CI: 1.1 similar to 2.5) compared to through VCT; the age of diagnosis was >= 50 years old (AHR = 9.5, 95%CI: 3.7 similar to 24.1) and 25 similar to 49 years old (AHR = 5.0, 95%CI: 2.0 similar to 12.3) compared to <= 24 years old; educated from junior and below (AHR = 3.4, 95%CI: 2.3 similar to 5.1) and Senior high school (AHR = 1.7, 95%CI: 1.1 similar to 2.7) compared to college and above. Conclusion: The AIDS-related mortality among PLHIV in Nanjing was relatively low. A higher risk for AIDS-related deaths were observed among PLHIV who unaccepted ART, whose baseline CD4 cell count was<200 cell/mu L, older age, and lower educated.