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 LuNanjing University of Chinese Medicine JXJiale XiNanjing University of Chinese Medicine XZXiang Zhang

Key Points

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.

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 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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