Backgrounds: There are few studies focus on the factors underlying the late initiation of ART in China. We\nanalyzed the trends in the median CD4 cell counts among different patient groups over time and the risk factors\nfor the late initiation of ART in Shanghai, China.\nMethods: A retrospective cross-sectional survey was made in the Department of Infectious Disease of Shanghai\nPublic Health Clinical Center which is a designated diagnosis and treatment center for HIV-positive patients in\nShanghai during the period of January 1st, 2008ââ?¬â??June 30th, 2014. Late ART initiation was defined as a CD4 cell\ncount <200 cells/mm3 or having a clinical AIDS diagnosis prior to ART initiation. Trends in the median CD4 cell\ncount at ART initiation and the proportion of late ART initiation by year were evaluated using Spearmanââ?¬â?¢s\ncorrelations and Chi-squared methods, respectively. We used a logistic regression model to analyze the risk factors\nfor late ART initiation. The related factors collected in the multivariate model were the patientââ?¬â?¢s age, gender,\ninfection routes and marital status.\nResults: A total of 3796 patients were analyzed in this study, with a median baseline CD4 cell count of 205 cells/mm3\n[interquartile range: 75ââ?¬â??287]. The median CD4 cell counts of patients initiating ART late increased from 76 cells/mm3 in\n2008 to 103 cells/mm3 in 2014 (p < 0.001), and the proportion of late ART initiation decreased from 80% to 45%\n(p < 0.001). The risk factors for late ART initiation were male gender, heterosexual transmission and older age\n(>30 years) (p < 0.001).\nConclusions: Notable improvements were made in the median CD4 cell count at ART initiation and the proportion of\nlate ART initiation from 2008 to 2014. However, persons with high risk of HIV exposure who are male, older even\nheterosexual orientation should be given more opportunities to receive frequently screening, earlier diagnoses and\ntimely treatment.
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