Survival Time and Influencing Factors Among People Living with HIV in Guilin City, Guangxi, China: A Retrospective Co-hort Study (1996– 2022)

Yan Feng¹Liyuan Ge¹Wenhui Cheng²Ying Zhuo¹Sijia Cao¹Jie Tang³Wuxiang Shi^2,4*Lingmi Zhou^1,2,4*

• ¹School of Public Health, Guilin Medical University, Guilin, China
• ²School of Humanities and Management, Guilin Medical University, Guilin 541199, Guangxi, China, Guilin, China
• ³Guilin Center for Disease Control and Prevention, Guilin, Guangxi Zhuang Region, China
• ⁴The Guangxi Key Laboratory of Environmental Exposomics and Entire Lifecycle Heath Research, Guilin, Guangxi, China, Guilin, China

Background: Despite significant advances in antiretroviral therapy (ART), substantial disparities in survival outcomes among people living with HIV (PLWH) persist in resource-limited settings. However, in Guangxi, a region heavily affected by the HIV/AIDS epidemic in China, research on the survival time of PLWH and its associated factors remains limited. This study aims to investigate the survival time and its influencing factors among PLWH in Guilin, Guangxi, from 1996 to 2022, filling an important gap in regional HIV epidemiological research. Methods: A retrospective cohort study method was used to study PLWH whose current address was reported as local in Guilin from 1996-2022. The life table method and Kaplan-Meier method were used to calculate the survival rate and draw the survival curve, and the Cox proportional hazards regression model was used to analyze the influencing factors of the survival time of PLWH. Results: A total of 16,068 HIV/AIDS patients were included in the study, with a mortality rate of 8.67/100 person-years. The median survival time of PLWH was 14.11 years (95% CI: 13.50–15.70), and the 1-year, 3-year, 5-year, and 10-year cumulative survival rates were 72%, 66%, 62%, and 54%, respectively. Cox proportional hazards model analysis identified factors significantly associated with increased risk of death, including male sex (HR = 1.425, 95% CI: 1.334–1.522), older age, low education level, unmarried status, farming occupation, and not receiving ART (HR = 10.578, 95% CI: 9.880–11.326). In contrast, individuals infected through heterosexual transmission and those identified through counseling and testing services had better survival outcomes. Lower CD4+T lymphocyte count at enrollment was associated with a higher risk of death. Conclusions: Survival time of PLWH is affected by many factors. In the context of the continuous improvement of policies and measures of Guilin City's anti-HIV attack project, behavioral interventions for key populations as well as publicity in rural areas should be strengthened, and early detection and treatment should be advocated in order to improve the quality of survival of PLWH and prolong their survival time. The findings of this study can provide scientific evidence for optimizing HIV prevention and control strategies in similar settings.