Mortality among People Living with HIV and AIDS in China: Implications for Enhancing Linkage

Li, Meng; Tang, Weiming; Bu, Kai; Mahapatra, Tanmay; Zhang, Xiayan; Yang, Feng; Chen, Fang‐Fang; Guo, Wei; Wang, Liyan; Ding, Zhengwei; Qin, Qianqian; Liu, Shiliang; Tucker, Joseph D.; Wang, Lu; Wang, Ning

doi:10.1038/srep28005

Cited by 15 publications

(16 citation statements)

References 22 publications

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“…In an era where effective and free testing and free treatment options are available in China, it is alarming that there is a substantial proportion of people were late diagnosed, and they are at higher risk of early death. A records-based retrospective cohort study in China found that the highest mortality rates for AIDS-related death and all-cause death were found in the first year of follow up after HIV diagnosis [ 52 ]. This phenomenon could be explained by the fact that about half of the participating cases had already progressed to AIDS before being identified, progression to AIDS was one of the strongest risk factors for AIDS-related death, with an aHR of 7.42 [ 52 ].…”

Section: Discussionmentioning

confidence: 99%

“Late for testing, early for antiretroviral therapy, less likely to die”: results from a large HIV cohort study in China, 2006–2014

Tang¹,

Mao²,

Tang

et al. 2018

BMC Infect Dis

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BackgroundTimely HIV testing and initiation of antiretroviral therapy are two major determinants of survival for HIV-infected individuals. Our study aimed to explore the trend of late HIV/AIDS diagnoses and to assess the factors associated with these late diagnoses in China between 2006 and 2014.MethodsWe used data from the Chinese Comprehensive Response Information Management System of HIV/AIDS (CRIMS). All individuals who tested positive for HIV between 2006 and 2014 in China and were at least 15 years of age were included. A late diagnosis was defined as an instance in which an individual was diagnosed as having AIDS or WHO stage 3 or 4 HIV/AIDS, or had a CD4 cell count less than 200 cells/mm3 at the time of diagnosis.ResultsAmong the 528,234 individuals (≥15 years old) newly diagnosed with HIV between 2006 and 2014, 179,700 (34.0%) people were considered to have received late diagnoses. The late diagnosis rate decreased from 33.9% in 2006 to 29.7% in 2014 (P < 0.01). Late diagnoses were more likely to be found among those who were 45–54 years old (adjusted odds ratio [aOR]: 3.25, 95% confidence interval [CI]: 3.17–3.34) or 55+ years old (OR: 2.94, 95% CI: 2.86–3.02), male (aOR: 1.15, 95% CI: 1.13,1.17), employed as a farmer or rural laborer (aOR: 1.13, 95% CI: 1.11–1.14), infected through blood or plasma transfusion (aOR: 4.18, 95% CI: 4.02, 4.35), diagnosed at hospitals (OR: 1.17, 95% CI: 1.15, 1.19), of Han ethnicity (aOR: 1.30, 95% CI: 1.28, 1.32), and married (OR: 1.12, 95% CI: 1.11,1.13). Of those people living with HIV (PLHIV) who received late diagnoses, 7.4%(8637) and 46.1%(28,462) ultimately died with or without receiving antiretroviral therapy within a year of diagnosis, respectively.ConclusionA large proportion of individuals with HIV/AIDS receive late diagnoses, and this proportion has witnessed a slight decline in recent years. Expanded testing is needed to increase early HIV diagnosis and antiretroviral therapy should be recommended to all diagnosed individuals as early as possible to reduce AIDS-related death.

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Section: Discussionmentioning

confidence: 99%

“Late for testing, early for antiretroviral therapy, less likely to die”: results from a large HIV cohort study in China, 2006–2014

Tang¹,

Mao²,

Tang

et al. 2018

BMC Infect Dis

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“…In China, the HIV epidemic has continued to expand, and the mortality attributable to HIV/AIDS has become a major public health concern[6]. In July 2017, approximately 728,270 persons were living with HIV/AIDS in China, and 223,798 died from AIDS-related illnesses[7].…”

Section: Introductionmentioning

confidence: 99%

Secular trends in HIV/AIDS mortality in China from 1990 to 2016: Gender disparities

et al. 2019

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Objectives HIV/AIDS has become the leading cause of death by infectious disease in China since 2009. However, the trend of gender disparities in HIV/AIDS has not been reported in China since 1990. Our study aimed to explore the secular trend of HIV/AIDS mortality in China from 1990 to 2016 and to identify its gender disparities over the past 27 years. Method The mortality data of HIV/AIDS were obtained from the Global Burden of Disease Study 2016 (GBD 2016). Logistic regression was used to estimate the prevalence odds ratio (POR) of gender for HIV/AIDS mortality in different surveys. Results The standardized mortality of HIV/AIDS in China rose dramatically from 0.33 per 100,000 people in 1990 to 2.50 per 100,000 people in 2016. The rate of HIV/AIDS mortality increased more quickly in men than in women, and the sex gap of mortality of HIV/AIDS widened. By 2016, the HIV/AIDS mortality in men was 3 times that in women and was 5.74 times that in women within the 75- to 79-year-old age group. Conclusions The mortality of HIV/AIDS in China is increasing, with a widening gender disparity. It is critical for policymakers to develop policies to eliminate these disparities and to ensure that everyone can live a long life in full health.

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“…Surprisingly, an increased mortality of HIV and AIDS was detected in the present study. We speculate that the increase of HIV and AIDS mortality may be partially explained by the accumulation of AIDS cases, since the cumulative AIDS-related mortality rates significantly increased over time after diagnosis [31]. Meanwhile, the inadequate provision of treatment services and difficulty with adherence were also likely to contribute to the increased mortality, particularly before 2003.…”

Section: Discussionmentioning

confidence: 95%

Changing epidemiological patterns of HIV and AIDS in China in the post-SARS era identified by the nationwide surveillance system

et al. 2018

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BackgroundChina has made substantial progress in tackling its HIV and AIDS epidemic. But the changing patterns of HIV and AIDS incidence based on the longitudinal observation data were rarely studied.MethodsThe reporting incidence (RI) and mortality data on HIV and AIDS in China covering 31 provinces from 2004 to 2014 were collected from the Chinese Public Health Science Data Center. To decompose the time-series data, Empirical Mode Decomposition (EMD) was applied to properly describe the trends of HIV and AIDS incidence. A mathematical model was used to estimate the relative change of incidence among provinces and age groups.ResultsA total of 483,010 newly HIV infections and 214,205 AIDS cases were reported between 2004 and 2014 nationwide. HIV infection increased from 13,258 in 2004 (RI 1.02 per 100,000 person years) to 74,048 in 2014 (RI 5.46 per 100,000). The number of AIDS cases increased from 3054 in 2004 (RI 0.23 per 100,000) to 45,145 in 2014 (RI 3.33 per 100,000). The overall relative changes for HIV infection and AIDS incidence were 1.11 (95% confidence interval [CI] 1.10–1.13) and 1.28 (95% CI 1.23–1.33), respectively. The relative increase for HIV and AIDS RI was higher in northwest provinces while lower in Henan, Xinjiang, Guangxi and Yunnan. The overall relative changes for HIV infection were 1.12 (95% CI 1.11–1.14) in males and 1.10 (95% CI 1.06–1.13) in females. For AIDS RI, the relative increases were 1.31 (95% CI 1.26–1.36) in males and 1.22 (95% CI 1.17–1.28) in females. The lowest relative increase was detected among young adults, while the largest relative increase (odds ratio [OR] > 1.30) was detected in people aged 55 years or above.ConclusionsHIV and AIDS showed an increasing trend in China from 2004 to 2014, respectively, but the epidemic tended to be under control among provinces and young people that used to have a high HIV and AIDS incidence. Northwest China and older people could be new “hop-spots” for HIV and AIDS risk.

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Mortality among People Living with HIV and AIDS in China: Implications for Enhancing Linkage

Cited by 15 publications

References 22 publications

“Late for testing, early for antiretroviral therapy, less likely to die”: results from a large HIV cohort study in China, 2006–2014

“Late for testing, early for antiretroviral therapy, less likely to die”: results from a large HIV cohort study in China, 2006–2014

Secular trends in HIV/AIDS mortality in China from 1990 to 2016: Gender disparities

Changing epidemiological patterns of HIV and AIDS in China in the post-SARS era identified by the nationwide surveillance system

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