Survival of People Living with HIV/AIDS from Pre-ART Era to Treat-all Era - China, 1985-2022

Introduction: A comprehensive analysis of nationwide survival trends for people living with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS, PLWHA) from the initial reported case to present has not been conducted. This study evaluated the survival outcomes of PLWHA reported in China from 1985 to 2022. Methods: We analyzed data from PLWHA recorded in the National HIV/AIDS Comprehensive Response Information Management System from 1985 to 2022. Survival rates were calculated using Kaplan- Meier curves, and factors associated with survival time were analyzed using Cox proportional hazard models. Results: Progressive relaxation of antiretroviral therapy initiation criteria led to significant improvements in survival rates across different diagnostic periods in China. The 1-year and 5-year cumulative survival rates increased from 85.2% and 66.1% in the 1985-2003 cohort to 91.1% and 81.4% in the 2016-2022 cohort. Cox proportional hazard analysis revealed elevated mortality risks among males, individuals aged >= 65 years, those with injection drug use or other transmission routes, hospital-tested patients, and those with lower CD4 counts at diagnosis or without treatment. Conclusions: Antiretroviral therapy has effectively reduced mortality risk among PLWHA in China. Future efforts should focus on expanding HIV testing to reduce the proportion of late diagnoses with lower CD4 counts and providing targeted, differentiated services for older populations to further decrease mortality risk among PLWHA.