Human immunodeficiency virus/acquired immunodeficiency syndrome prevalence, incidence, and mortality in China, 1990 to 2017: a secondary analysis of the Global Burden of Disease Study 2017 data

Abstract

Background: Despite almost two decades of well-funded and comprehensive response efforts by the Chinese Government, human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) remains a major problem in China. Yet, few studies have recently examined long-term trends in HIV/AIDS prevalence, incidence, and mortality at the national level. This study aimed to determine the prevalence, incidence, and mortality trends for HIV/AIDS over the past 28 years in China.

Methods: We conducted a descriptive, epidemiological, secondary analysis of the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 data. To evaluate trends in prevalence, incidence, and mortality over the study period from 1990 to 2017, we calculated values for annual percentage change (APC) and corresponding 95% confidence intervals (CIs) using joinpoint regression analysis.

Results: A significant increase in HIV/AIDS prevalence was observed for 1990 to 2009 (APC: 10.7; 95% CI: 10.4, 11.0; P < 0.001), and then remained stable for 2009 to 2017 (APC: 0.7; 95% CI: -0.3, 1.7; P = 0.1). A significant increase in HIV incidence was also observed for 1990 to 2005 (APC: 13.0; 95% CI: 12.6, 13.4; P < 0.001), and then a significant decrease was detected for 2005 to 2017 (APC: -6.5; 95% CI: -7.0, -6.1; P < 0.001). A significant increase in AIDS-related mortality rate was detected for 1990 to 2004 (APC: 10.3; 95% CI: 9.3, 11.3; P < 0.001), followed by a period of stability for 2004 to 2013 (APC: 1.3; 95% CI: -0.7, 3.3; P = 0.2), and then another significant increase for 2013 to 2017 (APC: 15.3; 95% CI: 8.7, 22.2; P < 0.001).

Conclusions: Although prevalence has stabilized and incidence has declined, AIDS-related mortality has risen sharply in recent years. These findings suggest more must be done to bring people into treatment earlier, retain them in treatment more effectively, actively seek to reenter them in treatment if they dropout, and improve the quality of treatment and care regimens.

Figure 1

HIV/AIDS prevalence (A), incidence (B), and mortality rate (C) by sex, for all ages, in China, 1990 to 2017, from the GBD, Injuries, and Risk Factors Study 2017 data. Estimated values are shown as solid lines, while 95% CIs are indicated by the shaded regions. CIs: Confidence intervals; GBD: Global Burden of Diseases; HIV/AIDS: Human immunodeficiency virus/acquired immunodeficiency syndrome.

Figure 2

Trends in HIV/AIDS prevalence (A), incidence (B), and mortality rate (C) in China, 1990 to 2017, from the GBD, Injuries, and Risk Factors Study 2017 data. APC was significantly different from 0 at the α = 0.05 level for trend 1 (blue) prevalence (A), trend 1 (blue) and trend 2 (green) for incidence (B), and trend 1 (blue) and trend 3 (red) for mortality (C). APC: Annual percentage change; CI: Confidence interval; GBD: Global Burden of Diseases; HIV/AIDS: Human immunodeficiency virus/acquired immunodeficiency syndrome.