Survival rate and the determinants of progression from HIV to AIDS and from AIDS to the death in Iran: 1987 to 2016

Objective: To examine the prognostic factors of progression from HIV to AIDS and AIDS to the death in people living with HIV/AIDS in Iran. Methods: In this registry-based retrospective cohort study, we recruited 28 873 HIV-infected people from 158 Behavioral Diseases Counseling Centers of Iran. Two outcomes of interest included survival rates from HIV diagnosis to AIDS and from AIDS to the death. We used Kaplan-Meier and Cox regression model to investigate survival rate and factors affecting on survival controlling effect of confounding factors. Results: The one, three, five, and ten-year survival rate from HIV to AIDS were 85%, 73%, 61% and 32%, and for AIDS to death were 90%, 81%, 74% and 55%, respectively. Multivariate Cox regression analysis indicated that the risk of progression from AIDS phase toward death in individuals with CD4 less than 200/mm3, infected with tuberculosis (TB) and not treated by antiretroviral therapy (ART) was 2.17 (95% CI: 1.62-2.90), 1.49 (95% CI: 1.01-2.20) and 4.88 (95% CI: 3.42-6.96) times higher respectively. The risk of progression to AIDS in patients with baseline CD4 less than 200/mm3 was 2.32 (95% CI: 2.14, 2.51) times higher than patients with CD4 > 200/mm3 (P=0.001). On the other hand, tuberculosis increases the risk of death by 49.0% (P=0.04). The hazard ratio of death in patients who did not receive ART was 4.88 (95% CI: 3.42, 6.96) times higher than patients who received ART (P<0.001). Conclusion: The early detection of HIV, the screening and treatment of TB and receiving the ART improve the survival of HIV/AIDS patients significantly, and prevent the transmission of HIV to other people.