Characteristics and Viral Suppression Among People Living With HIV From the National Free Antiretroviral Therapy Programme, 2019

Y Zhao; MJ Han XM Gan; Y Ma; DC Zhao

Disclosures

HIV Medicine. 2020;21(11):701-707. 

In This Article

Abstract and Introduction

Abstract

Objectives: This study aimed to present the clinical characteristics of and viral suppression in the national antiretroviral therapy (ART) cohort in China.

Methods: A cross-sectional study was conducted among the participants enrolled in China's National Free Antiretroviral Therapy Programme (NFATP) who were on ART at the end of 2019. The data used were from China's NFATP information system. The primary outcome was viral load (VL) suppression. Full virological suppression and low-level viraemia (LLV) were defined as VL < 50 copies/mL and between 51 and 999 copies/mL, respectively.

Results: At the end of 2019, 853 429 people living with HIV (PLWH) were on ART. The median age was 44 years [interquartile range (IQR): 33–54]. The majority of PLWH were 25–44 years old (47.2%) and male (73.5%) and reported HIV infection via heterosexual contact (64.5%). The median (IQR) baseline CD4 count was 257 (140–376) cells/μL. Among the 704 375 PLWH who were on ART for at least 12 months, 82.9% had full virological suppression, 6.5% had VL between 50 and 1000 copies/mL (LLV) and 4.3% had VL > 1000 copies/mL. Optimal full virological suppression occurred in participants who acquired HIV through homosexual contact (88.4%).

Conclusions: Although China can be credited for substantial progress in scaling up ART and viral suppression, challenges remain in some key populations, such as injecting drug users, participants with a history of treatment failure and hepatitis C virus co-infected people. To improve the programme output, additional monitoring and intervention for LLV are necessary.

Introduction

The implementation of antiretroviral therapy (ART) among people living with HIV (PLWH) has been proven to reduce HIV-related morbidity, prolong survival and decrease new HIV transmission.[1] Countries worldwide strive to reach the 90–90-90 targets established by the Joint United Nations Programme on HIV/AIDS for controlling the HIV epidemic.[2] At the end of 2019, 25.4 million (24.5–25.6 million) out of 38 million PLWH were accessing ART.[3]

China's National Free Antiretroviral Therapy Programme (NFATP) was officially launched in 2003, and ART initially focused on patients infected through former plasma donors or blood transfusion recipients in central China. The programme subsequently included injecting drug users (IDUs), commercial sex workers, pregnant women and children in the late 2000s. Previous publications reported on the outcome of the ART programme, including mortality and viral suppression.[4,5] Over the past decade, sexual contact has emerged as a major route of HIV infection, particularly heterosexual contact. The proportion of older HIV cases is also gradually increasing. For greater uptake of ART in various key populations, interventions aiming to simplify the ART initiation procedure were implemented nationally.[6] In 2016, the treatment standard of the national free ART programme was updated to provide ART for all PLWH regardless of CD4 count or clinical stage.[7]

Antiretroviral therapy implementation is scaling up rapidly in China. The number of patients receiving ART increased from 386 756 at the end of 2015 to 718 499 at the end of 2018. ART coverage of diagnosed PLWH was 83.4%, and among patients on treatment for at least 12 months, 94.2% achieved viral suppression.[8] Our programme defined viral suppression as patients with viral load (VL) ≤ 1000 copies/mL, but the definition of low-level viraemia (LLV; VL between 50 and 1000 copies/mL) is not clarified. The effect of LLV on clinical progress has received increasing attention. Patients with LLV have worse clinical progress and higher mortality.[9,10]

In recent years, the progress in the national ART programme has not been reported. In this study, we aimed to present the demographic and clinical characteristics of the updated national ART cohort in China. The whole cohort was divided into four groups according to the treatment standards in different periods. Classification of VL also specifically emphasized the LLV subgroup. From these data, we aimed to find the key population cohort experiencing virological failure and facilitate the modification of public health policy.

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