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Background <p>Research on HIV-infected drug users remains limited, despite their high risk for delayed antiretroviral therapy (ART) initiation and poor immune recovery. This retrospective cohort study analyzed the timing of ART initiation, factors associated with delayed initiation, and predictors of poor immune reconstitution among this group in China.</p> Methods <p>We conducted a retrospective analysis of HIV-positive drug users treated between January 2007 and December 2023 at Hengyang Third People’s Hospital (Hunan Province) and Lingshan People’s Hospital (Guangxi Zhuang Autonomous Region). Demographic and clinical characteristics, ART regimen, and treatment-related data were collected. Delayed ART initiation was defined as starting ART &gt; 30 days after diagnosis and was analyzed using multivariate logistic regression. Immunological non-responders (INRs) were defined as patients on ART for ≥ 48 months who failed to achieve final CD4 + T cell counts &gt; 350 cells/µL despite sustained viral suppression (VL &lt; 50 copies/mL). Predictors of poor immune reconstitution were assessed using Cox regression.</p> Results <p>Using a retrospective cohort of 503 HIV-positive drug users from two regional Chinese hospitals, 70.8% received national free ART regimens (2 nucleoside reverse transcriptase inhibitors (NRTIs) + 1 non-nucleoside reverse transcriptase inhibitor (NNRTI)). Delayed ART initiation occurred in 80.3% (<i>n</i> = 404). Diagnosis in 2017 or later was associated with significantly lower odds of delay compared to pre-2017 diagnoses (aOR = 0.18; 95% CI: 0.09–0.35; <i>p</i> &lt; 0.001). Among 335 HIV-positive drug-using patients receiving ART for ≥ 4 years, 52.2% (<i>n</i> = 175) were INRs. Poor immune reconstitution was significantly associated with diagnosis in 2013–2016 (HR = 381.82; 95% CI: 98.80-1475.64; <i>p</i> &lt; 0.001) and 2017 or later (HR = 1959.04; 95% CI: 471.64-8137.17; <i>p</i> &lt; 0.001) compared to pre-2009 diagnoses, and with having 1–2 regimen changes (HR = 1.67; 95% CI: 1.18–2.37; <i>p</i> = 0.004). Predominant NNRTI-based regimens with low resistance barriers, adverse effects, and poor adherence may have contributed to these outcomes.</p> Conclusion <p>Delayed ART initiation and poor immune reconstitution remain prevalent among HIV-positive drug-using populations in China despite “treat-all” policies. Higher baseline CD4 + counts and diagnosis in later years (particularly post-2017) were associated with delayed ART initiation and poorer immune restoration. Addressing regimen toxicity and improving integrated care models could improve outcomes and help achieve UNAIDS 95-95-95 targets in this vulnerable group.</p> Trial registration <p>Not applicable. This is a retrospective cohort study and was therefore not registered as a clinical trial.</p>

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Delayed ART initiation and poor immune reconstitution among drug-using HIV patients in two hospitals in China: a retrospective cohort study

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  • 发表日期：

    2026年4月16日

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  • Yingqin Liao,
  • Rongrong Ma,
  • Jianyu Cao,
  • Fengyan Huang,
  • Shushu Xie,
  • Hao Wang,
  • Ying Yang,
  • Jingjing He,
  • Dama Faniriantsoa Henrio Marcellin,
  • Zhong Chen,
  • Jiannan Lv,
  • Jing Ji

摘要

Background

Research on HIV-infected drug users remains limited, despite their high risk for delayed antiretroviral therapy (ART) initiation and poor immune recovery. This retrospective cohort study analyzed the timing of ART initiation, factors associated with delayed initiation, and predictors of poor immune reconstitution among this group in China.

Methods

We conducted a retrospective analysis of HIV-positive drug users treated between January 2007 and December 2023 at Hengyang Third People’s Hospital (Hunan Province) and Lingshan People’s Hospital (Guangxi Zhuang Autonomous Region). Demographic and clinical characteristics, ART regimen, and treatment-related data were collected. Delayed ART initiation was defined as starting ART > 30 days after diagnosis and was analyzed using multivariate logistic regression. Immunological non-responders (INRs) were defined as patients on ART for ≥ 48 months who failed to achieve final CD4 + T cell counts > 350 cells/µL despite sustained viral suppression (VL < 50 copies/mL). Predictors of poor immune reconstitution were assessed using Cox regression.

Results

Using a retrospective cohort of 503 HIV-positive drug users from two regional Chinese hospitals, 70.8% received national free ART regimens (2 nucleoside reverse transcriptase inhibitors (NRTIs) + 1 non-nucleoside reverse transcriptase inhibitor (NNRTI)). Delayed ART initiation occurred in 80.3% (n = 404). Diagnosis in 2017 or later was associated with significantly lower odds of delay compared to pre-2017 diagnoses (aOR = 0.18; 95% CI: 0.09–0.35; p < 0.001). Among 335 HIV-positive drug-using patients receiving ART for ≥ 4 years, 52.2% (n = 175) were INRs. Poor immune reconstitution was significantly associated with diagnosis in 2013–2016 (HR = 381.82; 95% CI: 98.80-1475.64; p < 0.001) and 2017 or later (HR = 1959.04; 95% CI: 471.64-8137.17; p < 0.001) compared to pre-2009 diagnoses, and with having 1–2 regimen changes (HR = 1.67; 95% CI: 1.18–2.37; p = 0.004). Predominant NNRTI-based regimens with low resistance barriers, adverse effects, and poor adherence may have contributed to these outcomes.

Conclusion

Delayed ART initiation and poor immune reconstitution remain prevalent among HIV-positive drug-using populations in China despite “treat-all” policies. Higher baseline CD4 + counts and diagnosis in later years (particularly post-2017) were associated with delayed ART initiation and poorer immune restoration. Addressing regimen toxicity and improving integrated care models could improve outcomes and help achieve UNAIDS 95-95-95 targets in this vulnerable group.

Trial registration

Not applicable. This is a retrospective cohort study and was therefore not registered as a clinical trial.