Determinants of antiretroviral therapy initiation and treatment outcomes for people living with HIV in Vietnam

Objectives: This study explores patient characteristics that are significantly associated with very late combination antiretroviral therapy (cART) initiation (CD4 count â‰100 cells/mm < sup > 3 < / sup > ) and examines the association between patient characteristics and treatment outcomes, CD4 recovery, and mortality. Design: Data were obtained from the clinical records of 2,198 HIV/AIDS patients in 13 outpatient clinics across 6 provinces in Vietnam. Methods: Multivariate logistic regression and Cox proportional hazards regression were used to identify patient characteristics that are significantly associated with very late cART initiation and to measure relationships between patient characteristics and treatment outcomes. Results: Very late cART initiation was significantly associated with being male compared with female (odds ratio [OR], 0.36; 95% CI, 0.23-0.58), becoming HIV infected through injecting drugs (OR, 2.13; 95% CI, 1.09-4.14), and having opportunistic infections at cART initiation (OR, 1.69; 95% CI, 1.02-2.86). Being male (female vs male: hazard ratio [HR] , 0.45; 95% CI, 0.20-0.98), very late cART initiation (timely vs late: HR, 0.18; 95% CI, 0.04-0.72), low baseline body mass index (BMI) (HR, 0.95; 95% CI, 0.92-0.98), and later baseline WHO clinical stage (WHO clinical stage IV vs combined group of stage I and II: HR, 5.70; 95% CI, 3.90-7.80) were significantly associated with death, whereas being female compared with male (HR, 1.51; 95% CI, 1.14-1.99) and timely cART initiation (HR, 35.45; 95% CI, 13.67-91.91) were significant predictors of CD4 recovery. Conclusions: Timely testing of patients for HIV, increasing use of CD4 count testing services, and starting cART earlier are essential to reduce mortality and improve treatment outcomes. © 2013 Thomas Land Publishers, Inc.