Virologic outcomes of first-line HAART and associated factors among Chinese patients with HIV in three sentinel antiretroviral treatment sites

OBJECTIVE To evaluate HIV drug resistance (HIVDR) among Chinese patients with HIV receiving first-line highly active antiretroviral therapy (HAART). METHODS Based on the WHO HIVDR surveys, a prospective cohort study with 12-month follow-up was conducted to estimate the prevalence of HIV RNA < 1000 copies/ml and HIVDR. RESULTS A total of 341 study subjects naive to prior antiretroviral therapy (ART) were followed up for a median of 12.1 months. The overall mortality rate was 9.9 per 100 person-years. The median of CD4 counts increased from 182 cells/mm(3) at baseline to 268 cells/mm(3) at 12 months (P < 0.0001). Of patients with plasma HIV-1 RNA concentrations >= 1000 copies/ml at 12 months, the proportions of resistance to non-nucleoside reverse transcriptase drugs, nucleoside/nucleotide reverse transcriptase inhibitors, and protease inhibitor drugs were 34.2%, 23.7% and 0%, respectively. The overall proportion of HIV RNA < 1000 copies/ml was 85.7% at 12 months. Occupation of farmer (AOR = 0.3, 95% CI: 0.08, 0.94; P = 0.0393) and HAART counselling and instruction through telephone (AOR = 2.8, 95% CI: 1.4, 5.6; P = 0.0047) were significantly associated with HIV RNA < 1000 copies/ml. CONCLUSION Our study demonstrated that the community-based ART had significant effects on viral suppression and immune recovery. HIVDR should be monitored in the long term to guide informed decisions on preventing HIVDR and choices of first- and second-line regimens.