ArticleInfection and drug resistance2026
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.
Article in Infection and drug resistance, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
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<350 cells/μL, also called late presenters, who initiated ART at the Nanjing Second Hospital from January 2017 to June 2022 were enrolled in this study and followed for at least 3 year and a maximum of 8 years. Based on the time from diagnosis to ART initiation, subjects were divided into a rapid ART group (ART initiation≤14 days after HIV diagnosis, median 12 days) and a delayed ART group (ART initiation>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.
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