Survival outcomes of older people living with HIV from 2001 to 2020 in Hunan, China: a retrospective cohort study.

BACKGROUND

The prevalence of HIV is on the rise among older adults, necessitating insights into their distinct characteristics and survival outcomes. This study aims to investigate the survival status and relevant factors among older people living with HIV (OPLHIV).

METHODS

This retrospective cohort study extracted data of OPLHIV aged 50 years and older between 2001 and 2020 from the Hunan provincial HIV/AIDS Comprehensive Response Information Management System. Joinpoint regression, Kaplan-Meier, and multivariate Cox proportional hazards regression analytic methods were used for the analysis.

RESULTS

All-cause mortality among 18,804 participants were 4,446. The median survival time was 175.33 months (95% confidence interval [CI]: 166.01-187.32). Survival rates at months 12, 36, 60, and 120 were 91%, 81%, 74%, and 59%, respectively. From 2001 to 2020, the crude mortality rate among OPLHIV showed an increasing and then decreasing trend, with a turnaround in 2013. Several demographic and clinical factors were associated with a higher risk of all-cause mortality. These include males (HR = 1.644, 95% CI: 1.522–1.776), 70 years and older at the HIV diagnosis (HR = 2.684, 95% CI: 2.472–2.914), farmers (HR = 1.387, 95% CI: 1.223–1.573), unmarried (HR = 1.216, 95% CI: 1.145–1.291), primary school or illiterate (HR = 1.527, 95% CI: 1.351–1.725), heterosexual transmission (HR = 2.134, 95% CI: 1.635–2.787). In addition, clinical characteristics such as baseline CD4 cell counts less than 200 cells/µL (HR = 2.068, 95% CI: 1.833–2.334), not initiating antiretroviral therapy within 30 days of diagnosis (HR = 1.284, 95% CI: 1.209–1.363) were also associated with a higher risk of all-cause mortality.

CONCLUSIONS

The overall survival rate of OPLHIV in Hunan, China, is concerning. Enhancing early HIV diagnosis and ensuring rapid initiation of antiretroviral therapy following diagnosis are crucial for improving survival outcomes.