Purpose: In the recent antiretroviral therapy (ART) era, a large proportion of Korean patients with human immunodeficiency vi-rus (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 [ad-justed 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.
Bibliographical noteFunding Information:
We thank the members of the Korea HIV/AIDS Cohort Study, Jun Hee Woo, Youn Jeong Kim, Won Suk Choi, Jang Wook Sohn, Seong Han Kim, Seong-Heon Wie, Ji-An Hur, Yeon Joon Park, Hyun-Ha Chang, Yoo Joo Kim, Hye Won Jeong, Jin Soo Lee, Ji-hyeon Baek, Jin Seo Lee, So Yeon Park, Taehyung Kim, Eun Jung Lee, and Kisoon Kim. This research was supported by a fund for the Chronic Infectious Disease Cohort Study (4800-4859-304, 2019-E5103-00) by Research of Korea Centers for Disease Control and Pre-vention.
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