Background To estimate crude mortality, excess mortality, and standardized mortality rates (SMR) among people living with HIV (PLHIV) initiating highly active antiretroviral therapy (HAART) in Luzhou, China 2006–2020, and assess associated factors. Methods PLHIV initiating HAART in the HIV/AIDS Comprehensive Response Information Management System (CRIMS) in Luzhou, China 2006–2020 were included in the retrospective cohort study. The crude mortality, excess mortality, and SMR were estimated. Multivariable Poisson regression model was used for analyzing risk factors associated with excess mortality rates. Results The median age among 11,468 PLHIV initiating HAART was 54.5 years (IQR:43.1–65.2). The excess mortality rate decreased from 1.8 deaths/100 person-years (95% confidence interval [CI]:1.4–2.4) in 2006–2011 to 0.8 deaths/100 person-years (95%CI:0.7–0.9) in 2016–2020. SMR decreased from 5.4 deaths/100 person-years (95%CI:4.3–6.8) to 1.7 deaths/100 person-years (95%CI:1.5–1.8). Males had greater excess mortality with the eHR of 1.6 (95%CI:1.2–2.1) than females. PLHIV with CD4 counts ≥ 500 cells/μL had the eHR of 0.3 (95%CI:0.2–0.5) in comparison to those with CD4 counts < 200 cells/μL. PLHIV with WHO clinical stages III/IV had greater excess mortality with the eHR of 1.4 (95%CI:1.1–1.8). PLHIV with time from diagnosis to HAART initiation ≤ 3 months had the eHR of 0.7 (95%CI:0.5–0.9) compared to those with time ≥ 12 months. PLHIV with initial HAART regimens unchanged and viral suppression had the eHR of 1.9 (95%CI:1.4–2.6) and 0.1 (95%CI:0.0–0.1), respectively. Conclusions The excess mortality and SMR among PLHIV initiating HAART in Luzhou, China decreased substantially from 2006 to 2020, but the mortality rate among PLHIV was still higher than general population. PLHIV who were male, with baseline CD4 counts less than 200 cells/μL, WHO clinical stages III/IV, time from diagnosis to HAART initiation ≥ 12 months, initial HAART regimens unchanged, and virological failure had a greater risk of excess deaths. Early and efficient HAART would be significant in reducing excess mortality among PLHIV.

Introduction The COVID-19 epidemic control and prevention strategies affected people’s sexual activities and behaviors. Little was known about long-term effects of COVID-19 prevention and control strategies on sexual behaviors among men who have sex with men (MSM). This study aimed to examine changes in risky sexual behaviors of MSM before and after the local epidemic. Methods An online survey was conducted nationwide from June 1 to June 10, 2022. MSM aged 16 years and above, residing in China were recruited through convenience sampling. A generalized estimating equation model with modified Poisson regression was used to analyze changes in multiple sexual partners, unprotected sex, mobility for sexual activity, and recreational substance use before and after the local epidemic. Results Compared to the pre-pandemic (36.5%), the prevalence of multiple sexual partners (11.5%) significantly decreased during the local epidemic and then increased after the local epidemic (25.2%) but remained lower than pre-pandemic, as did the prevalence of unprotected sex (31.1%, 19.4%, and 26.1%), mobility for sexual activity (7.5%, 2.8%, and 4.1%) and recreational substance use (47.7%, 27.2%, and 39.5%). Compared to the pre-pandemic, higher declines in the prevalence of risky sexual behaviors during the local epidemic existed among MSM living without a regular partner (44% decrease in unprotected sex and 46% in recreational substance use), with a bachelor’s degree and above (70% decrease in multiple sex partners, 39% in unprotected sex, 67% in mobility for sexual activity and 44% in recreational substance use), higher incomes (70% decrease in multiple sex partners), self-identified gay or bisexual/unsure (38-71%), and HIV infection (49-83% decrease respectively in these four indicators). After the local epidemic, the declines in the above indicators compared to the pre-pandemic were correspondingly. And higher declines existed among MSM living without a regular partner (8% decrease in unprotected sex and 13% in recreational substance use), with a bachelor’s degree and above (33% decrease in multiple sex partners), higher incomes (55% decrease in mobility for sexual activity), self-identified gay (51% decrease in mobility for sexual activity), and HIV infection (32%, 68%, 24% decrease respectively in unprotected sex, mobility for sexual activity and recreational substance use). Conclusions Risky sexual behaviors reduced considerably during the local epidemic, then seemed rebounded after the outbreak but wouldn’t return to pre-pandemic levels. More attention should be paid to vulnerable people with lower socio-economic status, HIV-positive, and sexual minorities for sustained HIV and COVID-19 prevention.

Background: The proportion of elderly people living with HIV (PLHIV) is increasing in China. To advance targeted interventions and substantially improve their quality of life, we investigate indicators of loneliness and sexual behavior among elderly PLHIV in 10 districts/counties in China during the COVID-19 pandemic. Methods: The demographic information and laboratory test results of the potential respondents were initially collected from the China Information System for Disease Control and Prevention. A two-stage stratified cluster sampling was used. The questionnaire survey was individually provided to all PLHIV aged +60. Results: We recruited 1017 valid respondents with a median age of 66 years (interquartile range of 63–71), of which 776 (76.3%) were male. Overall, 341 respondents (33.5%) lived alone, and 304 (29.9%) felt lonely. A total of 726 respondents (71.4%) informed others of their HIV diagnosis. Among the 726 respondents, children were the most common group with whom the older people shared their HIV infection status, accounting for 82.9%. Approximately 20% of the older PLHIV engaged in sexual behavior in the last year, and 70% reported not using condoms. A significantly greater risk of loneliness was found among the females (AOR = 1.542, CI: 1.084, 2.193), those who suffered discrimination from informed people (AOR = 4.719, CI: 2.986, 7.459), were diagnosed <1 year prior (AOR = 2.061, CI: 1.345, 3.156), those living alone (AOR = 2.314, CI: 1.632, 3.280), those having no friends (AOR = 1.779, CI: 1.327, 2.386), and those who had a divorced or widowed marital status (AOR = 1.686, CI: 1.174, 2.421). Conclusions: Compared with non-lonely participants, the lonely participants were more likely to have a rural registered residence, a lower education level, no friends, be divorced or widowed, live alone, and lack knowledge of smartphones and reproductive health. The influence of COVID-19 had caused social activities to be more confined to the community, which impacts elderly HIV patients suffering from severe discrimination within families and communities.

Objective Reducing the prevalence of treatment failure among people living with HIV (PLHIV) on highly active antiretroviral therapy (HAART) is crucial for improving individual health and reducing disease burden. This study aimed to assess existing evidence on treatment failure and its associated factors among PLHIV in mainland China. Methods We conducted a comprehensive search of PubMed, Web of Science, Cochrane Library, WanFang, China National Knowledge Infrastructure, and SinoMed databases. Relevant studies on treatment failure among PLHIV in mainland China until September 2022 were searched, including cross-sectional, case-control, and cohort studies. The primary outcome was treatment failure, and secondary outcomes were the potential influencing factors of treatment failure. We performed a meta-analysis to pool each outcome of interest, including meta-regression, subgroup, publication bias, and sensitivity analyses. Results A total of 81 studies were deemed eligible and included in the final meta-analysis. The pooled treatment failure prevalence among PLHIV in mainland China was 14.40% (95% confidence interval [CI]:12.30–16.63), of which the virological and immunological failure prevalence was 10.53% (95%CI:8.51–12.74) and 18.75% (95%CI:15.44–22.06), respectively. The treatment failure prevalence before and after 2016 was 18.96% (95%CI:13.84–24.67) and 13.19% (95%CI:10.91–15.64). Factors associated with treatment failure included good treatment adherence (odds ratio [OR] = 0.36, 95%CI:0.26–0.51), baseline CD4 counts>200 cells/μL (OR = 0.39, 95%CI:0.21–0.75), HAART regimens containing Tenofovir Disoproxil Fumarate (TDF) (OR = 0.70, 95%CI:0.54–0.92), WHO clinical stage III/IV (OR = 2.02, 95%CI:1.14–3.59) and age≥40 years (OR = 1.56, 95%CI:1.23–1.97). Conclusion The prevalence of treatment failure among PLHIV receiving HAART in mainland China was low and tended to decline. Poor adherence, low baseline CD4 count, HAART regimens without TDF, advanced clinical stage, and old age were contributing factors for treatment failure. Relevant intervention programs are needed with increasing treatment adherence through behavioral intervention or precise intervention targeting older adults.