Evaluation of factors associated with high advanced HIV disease and mortality in Southwestern China: a retrospective cohort study, 2005–2020

• Published in: Public health (London) Vol. 227; pp. 282 - 290
• Main Authors: Li, S.S., Li, K., Chen, H.H., Zhu, Q.Y., He, J.S., Feng, Y., Lan, G.H., Shao, Y.M.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.02.2024
• Subjects: Acquired Immunodeficiency Syndrome; Advanced HIV disease; AIDS; HIV Infections - diagnosis; HIV Infections - epidemiology; Humans; Mortality; Prevalence; Proportional Hazards Models; Retrospective Studies; Risk Factors; Severe immunosuppression; Advanced HIV disease; AIDS; Prevalence; Mortality; Severe immunosuppression
• ISSN: 0033-3506; 1476-5616
• DOI: 10.1016/j.puhe.2023.11.025

To assess the prevalence, all-cause mortality and determinants of advanced HIV disease (AHD) or severe immunosuppression (SIS) in the rural–urban communities of Southwestern China. Retrospective cohort study. Data on HIV/AIDS cases reported in 2005–20 were collected from Case Report System. A binary logistic regression model assessed the risk factors of AHD/SIS prevalence. Survival curves across rural–urban regions were compared using Kaplan–Meier estimates and log-rank tests. Determinants of all-cause mortality were identified using the Cox proportional hazard model. Among 14,533 newly diagnosed HIV/AIDS patients, 7497 (51.6%) presented with AHD and 2564 (17.6%) with SIS. Compared with urban patients, rural patients had a higher prevalence of AHD (56.7% vs 40.7%) and SIS (20.1% vs 12.4%), all-cause mortality (AHD 12.3 vs 5.6, SIS 16.3 vs 5.5, per 100 person-years). Their 5-year survival probability (AHD 59.5% vs 77.1%; SIS 54.4% vs 76.3%) and mean survival time (AHD 106.5 vs 140.6 months, SIS 95.3 vs 144.2 months, p < 0.0001) were lower. Rural patients had an increased risk of SIS prevalence (adjusted odds ratios 1.45, 95% confidence interval [CI] 1.28–1.64; p < 0.0001) and mortality of the total cohort (adjusted hazard ratios 1.41, 95% CI 1.29–1.55; p < 0.0001), AHD cohort (1.38, 1.24–1.54; p < 0.0001), and SIS cohort (1.49, 1.23–1.81; p < 0.0001). A high prevalence of AHD/SIS was a severe phenomenon that caused high mortality in rural areas. A regional point-of-care strategy targeting AHD/SIS detection and management is essential for reducing the mortality risk.