China has reduced its AIDS mortality by two-thirds since it began distributing free antiretroviral drugs in 2002, a new study finds. But the improvements were seen largely in patients who acquired HIV through blood transfusion, rather than through sex or drug use.
The country’s program, called the China National Free Antiretroviral Treatment Programme (CNFATP), has increased drug coverage from zero patients to 63% of all patients who need treatment between 2002 and 2009. According to a review of the program in the journal Lancet Infectious Diseases, drug treatment has improved overall mortality — measured in “person-years,” an estimate of the number of years that would have been lost due to early death from AIDS — by 64%.
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Mortality dropped from 39.3 deaths per 100 person-years in 2002 to 14.2 deaths per 100 person-years by 2009. “Given the size of the country, and the geographical spread of individuals with HIV…China’s treatment coverage is remarkable…but it is far from the goal of complete coverage of people who meet the treatment criteria,” the study’s authors, led by Fujie Zhang from the National Centre for AIDS/STD Control and Prevention, said in a statement.
About 740,000 people in China are estimated to have HIV, of whom 323,252 have been tested and officially reported as of 2009, the study said. Among those, 82,540 people are receiving treatment. Most of the patients who are being treated through CNFATP contracted the virus through plasma donations in the 1990s.
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The study reports that among people who were infected with HIV through the government-run blood donation program, 80% were receiving treatment at the time of the study. By contrast, 62% of those who acquired the virus through sex and 43% of those who were infected by sharing drug needles were receiving antiretroviral therapy.
The drops in mortality in the three populations were similarly skewed. Among blood tranfusion patients receiving treatment, there were 6.7 deaths per 100 person-years. However, among those infected sexually, there were 17.5 deaths per 100 person-years; among injecting drug users, there were 15.9 deaths per 100 person-years.
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What’s more, people with HIV in China are still subject to discrimination from health-care providers. The New York Times reported:
A different report, released Wednesday by the International Labor Organization of the United Nations, criticized China’s health-care system, saying that people infected with H.I.V., the virus that causes AIDS, were frequently turned away by hospitals.
The report, based on interviews with patients, health care workers and hospital managers, says patients are sent by general hospitals to infectious-disease hospitals. But they often refuse to perform surgery, for example, for fear that paying patients will avoid the hospital if word spreads that it operates on AIDS patients. China’s national center for AIDS control, a co-author of the report, agreed that hospital discrimination was a problem.
“Injecting drug users, those infected sexually, men, and those underserved by the public health system, such as migrants, the elderly, and minority groups, are at greater risk of not receiving treatment. Increased attention must be given to these populations to diagnose HIV infection earlier and increase treatment coverage,” said the authors of the Lancet study.
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China is now debating whether to start patients on antiretroviral therapy as soon as they test positive for HIV, rather than waiting until their immune cell count drops below a certain threshold. Last week, the results of a large U.S. government-sponsored trial shored up the life-saving benefits of early antiretroviral therapy, finding that early treatment helps prevent transmission of HIV in heterosexual couples.