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.