Antiretroviral therapy initiation and its associations with social determinants and clinical outcomes: a retrospective cohort study in Hunan, China

This is the authors' abstract. We don't add key points for this paper.

Since 2016, all people living with HIV (PLHIV) in China have been recommended to initiate antiretroviral therapy (ART) regardless of CD4 count. This study examined the associations of social determinants and disease characteristics at diagnosis with ART initiation timing, and assessed the impact of initiation timing on clinical outcomes. We conducted a retrospective cohort study using data from 31,819 PLHIV diagnosed in Hunan Province between 2016 and 2021, with follow-up until 2023. Outcomes included HIV viral suppression, CD4 recovery, and all-cause mortality. Multivariable Cox regression models were applied to estimate adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs), using a significance level of α = 0.05. The mean age of participants was 46.12 years, 45.92% were over 49 years, and 77.16% were male. Median ART initiation time was 17 days (interquartile range, 8–35). Social determinants and disease characteristics significantly influenced initiation timing. Delayed initiation beyond 30 days was associated with reduced viral suppression (aHR 0.879, 95% CI 0.867–0.891), lower CD4 recovery (aHR 0.817, 95% CI 0.802–0.832), and increased all-cause mortality (aHR 1.299, 95% CI 1.200–1.406). No significant differences were observed between 0–7 days and 8–30 days. These findings underscore the importance of initiating ART within 30 days of diagnosis.