The Risk Factors Of Fatality And Effect Of Antiviral Therapy In Hiv-infected Female Sex Workers In Southern China From 2009 To 2018:A Retrospective Cohort Study

Objective:This study analyzed and evaluated the late presentation(LP)impacted on fatality of HIV-infected female sex workers(FSWs)in Guangxi Zhuang Autonomous Region,and its influencing factors,and analyze the anti-retroviral therapy(ART)and effect and its influencing factors of HIV-infected FSWs in Guangxi,and provide a scientific basis for formulating coping strategies.Methods:We carried out a study of HIV-infected FSWs of Guangxi,China,from January 2009 to December 2018.Kaplan-Meier analysis was used to compare fatality rate in groups.The cox proportional hazard model was used to assess the influencing factors of fatality in HIV-infected FSWs.And logistic regression analysis was use to display various associated risk factors for late presentation of those HIV-infected FSWs.The effect of antiviral therapy was evaluated from virology,immunology and clinical symptoms,and the influencing factors of HIV-infected FSWs antiviral therapy were analyzed by cox proportional hazard model.All fatality rates are those of AIDS-related events during the follow-up.Results:1.In this study,1024 FSWs were reported as positive HIV/AIDS patients in Guangxi,China during January 2009 and December 2018.Of these1024 patients,whose epidemic information was completely available in 949were screened,and 38 cases without CD4~+T cell count information were excluded.The fatality rate among HIV-infected FSWs shown a downward trend in 10 years,and overall fatality rate was 8.3%,76 deaths were found(2.5/100 person-years of follow-up).2.Compared with self-test and consultation,HIV-infected FSWs from other diagnostic sources(AHR:2.149,95%CI:1.175-3.932)have an increased risk of death,while the baseline CD4~+T lymphocyte cells count200≤CD4+T<350cells/μL(AHR:0.461,95%CI:0.259-0.822)and CD4~+T≥500cells/μL(AHR:0.237,95%CI:0.102-0.549),and receiving antiretroviral therapy(AHR:0.177,95%CI:0.106-0.296)have a lower risk of death.3.540 cases(59.3%)of HIV-infected FSWs showed late presentation at the time of diagnosis(including 183 cases with defined events related to AIDS),and371 cases(40.7%)of HIV-infected FSWs had baseline CD4~+T cells count was≥350cells/μL(non-LP).HIV-infected FSWs from other ethnic groups besides the Han and Zhuang(AOR:0.678,95%CI:0.468-0.983),household registration from other provinces and abroad(AOR:0.663,95%CI:0.457-0.877)have a relatively low risk of late presentation.4.A total of 661 cases of HIV-infected FSWs who received antiviral therapy were included.50 cases(7.6%)had virological failure(VL≥400copies/m L),80cases(12.1%)had immunological failure,13 cases(2.0%)had both virological failure and immunological failure,and 28 cases(4.2%)died.5.Unmarried(AHR:2.377,95%CI:1.020-5.537),occurrence of AIDS-related diseases(AHR:3.899,95%CI:1.511-10.055)and missed medications(AHR:3.252,95%CI:1.747-6.052)within 6-12 months after ART of HIV-positive FSWs have a relatively high risk of virological failure.6.The count of 350<CD4~+T≤499cells/μL at the time of treatment,(AHR:2.708,95%CI:1.258-5.826)of HIV-infected FSWs has a relatively high risk of immunological failure.Conclusion:The fatality rate of HIV-infected FSWs diagnosed in Guangxi from2009 to 2018 is low,but the incidence of late presentation is high.The effect of antiviral therapy is obvious,and the virological failure rate and immunological failure rate are low.Early treatment should be promoted,to improve the timeliness and coverage of ART.It is necessary to improve medication compliance,and the type of AIDS disease as a predictor of virological failure should be paid more attention.Once AIDS-related symptoms and diseases appear,they should be treated together in time.