Establishing CD4 Thresholds for Highly Active Antiretroviral Therapy Initiation in A Cohort of HIV-Infected Adult Chinese in Hong Kong

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Abstract
Studies on the use and outcome of highly active antiretroviral therapy (HAART) in HIV-infected Chinese have been scarce. We evaluated risk of progression to (1) nonaccidental death and (2) new AIDS-defining illness (ADI) or death in 223, 89.9% of 248 HIV-1-infected adult Chinese patients who were first initiated on HAART between 1997 and 2002, and followed through 2003. The study subjects were mostly male (88.3%), aged between 30-49 years (43.9%), and acquired HIV via sexual contact (95.7%). After a median follow-up of 38.6 months, 13 nonaccidental deaths were observed. Overall, 25 patients developed new ADI or died. Using Kaplan-Meier analyses, there was no survival difference of starting HAART at various CD4 strata but a higher risk of progression to new ADI/death in patients with pretreatment CD4 count less than 100 cells per microliter (p = 0.01). On Cox proportional hazards multivariate regression analyses, pretreatment CD4 counts of less than 100 cells per microliter and less than 150 cells per microliter but not higher levels were the cutoffs for increased progression to death (adjusted hazard ratio [HR] = 4.90, 95% confidence interval [CI]: 1.08-22.22) and new ADI/death (adjusted HR = 14.44, 95% CI: 1.95-106.89), respectively. Age 50 years or greater was the only other independent predictor of mortality and new ADI/death after HAART. Further studies are indicated to validate and discern implications of these preliminary findings of a lower CD4 threshold for antiretroviral therapy in a small Chinese HIV cohort.