What question did this study set out to answer?

To explore the relationship between timing of antiretroviral therapy initiation and mortality in late-presenting individuals with HIV.

April 23, 2026Infection and Drug Resistance0 citationsOpen Access

Risk of Mortality Associated with Rapid versus Delayed ART Initiation and Associated Factors Among Late-Presenting People with HIV: An 8-Year Retrospective Analysis in China

LLLianfeng Lu JXJiale Xi XZXiang Zhang

Puntos clave

To explore the relationship between timing of antiretroviral therapy initiation and mortality in late-presenting individuals with HIV.
Analyzed treatment-naive late-presenting individuals with CD4+ T cell count < 350 cells/μL from 2017 to 2022.
Divided subjects into rapid (≤ 14 days) and delayed (> 14 days) ART initiation groups.
Utilized Cox proportional hazards model to assess mortality risk factors.
Total mortality rate was 4.42%, with 68 deaths among 1538 participants.
No significant difference in mortality rates between rapid (3.92%) and delayed (4.63%) ART groups.
Stay single, divorced, or widowed, and low baseline CD4+ T cell count were significant risk factors.

Resumen

Objective: To explore the association between the timing of antiretroviral therapy (ART) initiation and all-causes mortality, as well as related risk factors, for late presenters living with HIV (PWH). Methods: Treatment-naive PWH with CD4+T cell count 14 days after HIV diagnosis, median 35 days), with a significant difference in initiation time (p< 0.001). The difference in mortality, cause of death and immunological profiles between the two groups were compared, and a Cox proportional hazards model was constructed to analyze death-related risk factors. Results: A total of 1538 PWH were included in the study, and 68 patients died, with the total case mortality rate of 4.42%. There were 459 (29.8%) patients in the rapid ART initiation group, and the mortality rate was 3.92% (18/459), there was no significant difference in case mortality compared to the delayed initiation group (4.63%, 50/1079). The most common cause of death among these patients was non-AIDS-related cancer. Besides, risk factors for death were being single, divorced or widowed, and having a baseline CD4+T cell count < 200 cells/μL. Conclusion: The all-cause mortality rate of PWH with CD4+T cell counts < 350 cells/μL was 4.42%, and the cause of death in China have shifted over time. Rapid initiation of ART was not significantly associated with reduced mortality in this cohort; however, low CD4+T cell counts at baseline and social factors showed a more significant association with mortality. Keywords: HIV/AIDS, antiretroviral therapy, CD4+T cell count, mortality

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