32-Year Cohort Study Reveals Antiretroviral Therapy Reduces Mortality Hazard in Iranian HIV Patients

A comprehensive 32-year population-based cohort study conducted in Mazandaran province, Iran, provides critical real-world evidence regarding the survival outcomes of individuals living with HIV/AIDS, highlighting the profound impact of antiretroviral therapy (ART) and the detrimental effects of substance use.

The research, which spanned nearly three decades, analyzed data from 507 HIV/AIDS patients registered in the province between 1991 and 2023. This extensive longitudinal perspective addresses a significant gap in regional literature by quantifying the association between ART and long-term survival in a large, real-world setting.

Initial observations within the cohort indicated a high prevalence of risk factors among the patients. Of the 507 participants, 72.78% were male, and concerning behavioral patterns were prevalent, with 63.87% reporting addiction and 64.11% engaging in unsafe sexual practices. Over the follow-up period, the mortality rate reached 37.28%, while 5.13% of the cohort was lost to follow-up, and 57.59% were censored, reflecting the complex nature of tracking long-term patient outcomes in public health studies.

The core findings of the study, derived from the multivariable Cox proportional hazards model, strongly implicated the absence of ART as the most significant predictor of mortality. Patients who did not receive ART demonstrated the strongest association with death, evidenced by a Hazard Ratio (HR) of 3.72 (95% CI: 2.52–5.48; p < 0.001). This indicates that, relative to those receiving treatment, untreated individuals faced a nearly four-fold increased risk of mortality. Furthermore, the study identified addiction history as an independent risk factor for poorer survival, with an HR of 2.41 (95% CI: 1.04–5.61; p = 0.04).

The survival analysis yielded stark differences in mean survival time between the two groups. Patients who were receiving ART exhibited a mean survival time of 16.24 years (95% CI: 15.14–17.34). In contrast, patients who were untreated had a significantly shorter mean survival time of 8.72 years (95% CI: 7.14–10.31). These quantitative results underscore the life-saving potential of ART in extending life expectancy and reducing the hazard of death within this specific population.

However, the researchers provided a crucial caveat regarding the interpretation of these results. They emphasized that the association between ART and improved survival must be interpreted as observational. A critical limitation noted is that ART receipt was collinear with the treatment era, meaning the period when ART became available, and potential immortal-time bias may have inflated the apparent benefit observed in the treated group. This methodological consideration is vital for understanding the true causal effect of the therapy.

The study’s conclusions extend beyond merely documenting survival rates; they offer a clear framework for public health intervention. The researchers strongly recommend a multi-pronged approach. This includes targeted interventions specifically designed for individuals who inject drugs, given the high prevalence of addiction and its independent link to increased mortality. Simultaneously, the findings advocate for the expansion of ART access across the region and the strengthening of adherence support mechanisms to ensure patients remain on treatment.

This 32-year cohort study from Mazandaran province serves as a powerful testament to the efficacy of modern medical interventions in managing chronic infectious diseases, while simultaneously highlighting the persistent social and behavioral challenges that must be addressed alongside clinical care. By linking the reduction in mortality hazard directly to ART usage and identifying addiction as a primary independent risk factor, the research provides actionable data for policymakers aiming to improve long-term outcomes for people living with HIV/AIDS.

Subject of Research: The impact of antiretroviral therapy on mortality and the influence of substance use among HIV/AIDS patients in a long-term cohort study.

Article Title: Antiretroviral therapy and reduced hazard of mortality in HIV/AIDS patients: a 32-year cohort study from Iran

Article References: Buzari, S. Z., Telmadareh, M. S., & Saleh, E. (2026). Antiretroviral therapy and reduced hazard of mortality in HIV/AIDS patients: a 32-year cohort study from Iran. BMC Infectious Diseases. https://doi.org/10.1186/s12879-026-14713-5

Image Credits: AI Generated

DOI: 10.1186/s12879-026-14713-5

Keywords: HIV/AIDS, Antiretroviral Therapy, Cohort Study, Mortality Hazard, Public Health, Mazandaran, Addiction, Epidemiology, Antiretroviral, therapy, reduced, hazard