[Epidemiological characteristics and influencing factors on mortality of HIV-infected patients in Zhejiang Province, 2003-2022].

Objective

To explore the epidemiological characteristics and influencing factors of mortality among HIV-infected patients in Zhejiang Province, China, and to provide evidence for optimizing regional prevention strategies to reduce deaths among HIV-infected patients.

Methods

The data were obtained from Chinese Disease Prevention and Control Information System and Zhejiang Chronic Disease Information Management System. A retrospective cohort study was established, inclusion criteria for study subjects were HIV-infected patientss whose current address was in Zhejiang and whose diagnosis time was from January 1, 2003 to December 31, 2022. Mortality density (per 100 person-years) and mortality proportion were calculated. Chi-square tests were used to compare mortality differences across subgroups, and Cox proportional hazards regression models identified mortality-associated influencing factors, with hazard ratios (HR) and 95%CI reported.

Results

Among 43 975 reported HIV-infected patients,there were 5 179 deaths including 1 918 AIDS-related deaths, 2 474 non-AIDS-related deaths and 787 unclassified deaths. The mortality densities for all-cause, AIDS-related, non-AIDS-related, and unclassified deaths were 1.86, 0.69, 0.89, and 0.28 per 100 person-years, respectively. The proportion of all-cause mortality showed a declining trend (from 1.67% in 2003 to 1.19% in 2022,Z=32.92,P<0.001). AIDS-related deaths decreased over time, while non-AIDS-related deaths exhibited a continuous upward trend. The results of the Cox proportional hazards regression model analysis showed that risk factors for HIV-infected patients' mortality included those who received antiviral therapy (ART) with 3-5 months, 6-11 months, ≥12 month of diagnosis and no ART (aHR were 1.26, 1.42, 1.17, and 9.39, respectively), the age at the time of diagnosis were 50- and ≥65 years old (aHR were 2.03 and 3.63, respectively). Protective factors included being female (aHR=0.65), later diagnosis period (2016-2022) (aHR=0.87). Married with a spouse (aHR=0.85). Educational levels were junior high school (aHR=0.88), high school/vocational school (aHR=0.66), college and above (aHR=0.46), Baseline CD4+T lymphocyte counts were 200-349 cells /μl (aHR=0.46), 350-499 cells/μl (aHR=0.36), and ≥500 cells/μl (aHR=0.34).

Conclusions

From 2003 to 2022, the number of HIV-infected patients' deaths in Zhejiang Province showed an overall increasing trend, but the mortality proportion declined. Greater attention should be paid to non-AIDS-related deaths, with efforts focused on establishing chronic disease management pathways for elderly HIV-infected patients and strengthening multidisciplinary care for non-AIDS-related conditions.