INTRODUCTION
Acquired immune deficiency syndrome (AIDS), which induced by human immunodeficiency virus (HIV) has continued to be a worldwide public health problem and 40.1 million [33.6 million–48.6million] deaths since the start of the epidemic. Furthermore, 38.4 million [33.9 million–43.8 million] people globally were living with HIV in 2021 [1]. Thanks for the advent of ART, millions of people ‘s life were saved [2]. Although ART is well established effective therapy for the treatment of AIDS, but with the increase of ART duration, non-adherence, drug resistance, first-line treatment failures have become more common, and a challenge to achieving better treatment response is emerging [3]. More and more PLHIV had to be initiated second-line regimen. A study on HIV/AIDS patients’ therapy in Asia reported that 19% patients had taken second-line ART [4]. Moreover, patients who switch to second-line ART after first-line treatment failure have improved outcome. However, the proportion of patients failing on second-line ART remains high. The second-line treatment failure rate was 23.1%, 19% and 12.3% after 12months treatment in resource-limited settings [5], sub-Saharan Africa [6] and Ethiopia [7] respectively. Boosted protease inhibitor (PI) + two nucleoside reverse transcriptase inhibitor (NRTI) combinations is recommended as the preferred strategy for second-line ART [8]. Recently, the World Health Organization (WHO) recommended third-line ART for PLHIV, however, access to this therapy remains restricted by high cost and implementation barriers, so maximizing the durability of first or second-line regimens is an emerging global priority.
Henan province lies in the middle of China, being one of HIV High Incidence areas. Since 2003, ART had been used among those patients according to guidelines of the handbooks of national ART [9]. Second-line ART was implemented in Henan Province in 2009, and subsequent studies mainly focused on drug resistance and treatment failure [10, 11], little on the mortality. Hence, we design a retrospective cohort study to analysis the mortality of PLHIV after second-line ART and to identify the determinants of survival.