Estimates of HIV Incidence, Prevalence, and Mortality in China 2018

A thorough and precise comprehension understanding of the HIV epidemic is crucial for effective HIV prevention and control. This study aimed to update the estimates of the overall HIV burden in China in 2018 and to assess the trends of HIV prevalence, incidence, and mortality from 1985 to 2018. The Estimation and Projection Package (EPP)/Spectrum software was utilized for estimation, a method highly recommended by UNAIDS. Data were collected from more than 1800 HIV sentinel surveillance sites, population-based seroprevalence surveys, and HIV screening of antenatal clinics and pre-marital medical check-ups across the country. Assumptions about age and sex were used to adapt the parameters of disease progression, including CD4 progression rates and mortality rates for individuals on and off antiretroviral therapy (ART). Joinpoint (version 4.7.0.0) was used to analyze the trends of prevalence, incidence, mortality, and fatality rates from 1985 to 2018. In 2018, the total number of people living with HIV (PLWH) adults in China was estimated to be 1.23 million, corresponding to approximately 106.5/100 000 in the country. A total of 71.8% of adult PLWH were men. Over half of PLWH (58.6%) were infected through heterosexual contact, about one-third (30.2%) through male-to-male transmission, 9.0% through IDU, and 2.3% due to former plasma donation. HIV incidence in adults reached its first small peak in 1992 with 52 400 new infections (95% confidence interval: 2700-920 000). After a brief period of rapid decline between 1992 and 1994, the annual number of new infections among adults increased again and remained relatively stable at 81 000 (95% uncertainty interval [UI]: 60 000-105 000) in 2018. In recent years, the number of new infections through blood donation has been eliminated, and the number of infections through injecting drug use has been kept low. Sexual contact became the predominant transmission route, while casual sexual contact became increasingly common. Overall, HIV mortality has been steadily increasing and has recently begun to decline during the period of 2012-2018. The number of deaths from HIV/AIDS in 2018 was approximately 35 000 (95% UI: 30 000-41 000). The number of estimated PLWH in China has exceeded one million, due to the ongoing occurrence of new infections and longer survival rates. HIV transmission through blood products has been eradicated. Casual sex has become a significant mode of transmission. It is recommended to enhance the implementation of strategies and measures for sexual communication in the general population and to bolster multidisciplinary research.