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/mm;, 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/mm;was 2.32（95% CI: 2.14, 2.51） times higher than patients with CD4 > 200/mm;（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.