Demographic characteristics A total of 19,453 ethnic minority HIV / AIDS cases were included in the study. Males accounted for 67.74% ( 13 177 / 19 453 ) ; the age at diagnosis of HIV positive was 0–92.00 years old, with a median age of 43.00 years ( inter quartile range P25-P75 : 31.00–57.00 years ), and 74.83% ( 14 557 / 19 453 ) were 20–59 years old. Married cases accounted for 39.71% ( 7 725 / 19 453 ), divorced or widowed cases accounted for 36.99% ( 7 195 / 19 453 ). Illiteracy accounted for 13.78% ( 2 681 / 19 453 ), primary school education accounted for 37.84% ( 7 361 / 19 453 ), and junior high school education accounted for 32.39% ( 6 301 / 19 453 ). Farmers accounted for 65.98% ( 12 835 / 19 453 ), domestic or unemployed accounted for 16.56% ( 3 222 / 19 453 ) ; among the ethnic minorities, Miao accounted for 26.90% ( 5 233 / 19 453 ), Buyi accounted for 25.57% ( 4974 / 19 453 ), Dong accounted for 16.79% ( 3 267 / 19 453 ), Shui accounted for 8.83% ( 1 718 / 19 453 ), Tujia accounted for 8.53% ( 1 659 / 19 453 ), Yi accounted for 5.11% ( 994 / 19 453 ), and other ethnic minorities accounted for 8.27% ( 1 608 / 19 453 ). Among the routes of HIV infection, 92.88% ( 18 067 / 19 453 ) were sexually transmitted, 5.71% ( 1 111 / 19 453 ) were injected with drugs, and 1.41% ( 275 / 19 453 ) were mother-infant and others.
76.11% ( 14 805 / 19 453 ) participated in HAART, of which 58.84% ( 11 447 / 19 453 ) received HAART within 6 months after diagnosis of HIV positive. The time from diagnosis of HIV positive to initiation of HAART M = 0 month ( P25-P75 : 0–4.00 month ), the mortality rate of HAART group was 4.57 / 100 person-years ( 2 611 / 57 102.25 ), and the mortality rate of non-HAART group was 52.02 / 100 person-years ( 4 178 / 8 029.92 ). Both groups were with distinct statistical differences. 14.05% ( 2 733 / 19 453 ) never received CD4 + T lymphocyte test, and 85.95% ( 16 720 / 19 453 ) received CD4 + T lymphocyte test. Among them, 82.19% ( 13 742 / 16 720 ) received CD4 + T lymphocyte test within 3 months after diagnosis of HIV positive. 13.34% ( 2 230 / 16 720 ) and 20.02% ( 3 347 / 16 720 ) of the first CD4 + T lymphocyte count ≥ 500 cells / µl.
Death of all causes The total mortality rate of the subjects was 10.42 / 100 person-years ( 6 789 / 65 132.17 ), the shortest follow-up time was 0 days, the longest was 23.58 years, and the median follow-up time was 2.50 years ( P25-P75 : 8.33 years-4.92 years ). The proportion of all-cause death was 34.90% ( 6 789 / 19 453 ). The proportions of deaths caused by AIDS-related diseases, AIDS-unrelated diseases, drug overdose, accident, suicide and other causes were 32.41% ( 2 200 / 6 789 ), 8.15% ( 553 / 6 789 ), 2.64% ( 179 / 6 789 ), 13.26% ( 900 / 6 789 ), 1.31% ( 89 / 6 789 ) and 42.24% ( 2 868 / 6 789 ), respectively. Although the proportion of HAART coverage increased from 0.28% in 2005 to 74.90% at the end of 2020, the mortality rate of the subjects remained above 11.00 / 100 person-years from 2007 to 2013.Until the proportion of HAART coverage was close to 50% in 2014, the mortality rate remained below 10.00 / 100 person-years and maintained a high level of death. As shown in Table 1. The proportion of deaths in the first year after reporting was 49.85% ( 3384 / 6789 ), while deaths due to AIDS-related diseases accounted for 32.41% ( 2200 / 6789 ), deaths unrelated to AIDS accounted for 25.35% ( 1721 / 6789 ), and 42.24% ( 2868 / 6789 ) could not be determined.
Table 1
HIV / AIDS mortality and HAART among ethnic minorities in Guizhou Province, 1996–2020
Infection period (year) | HIV Infection and Mortality | All-cause mortality (/100 person year) | HAART situation |
Number of initial cases | Number of new cases reported during the period | Number of deaths during the period (all death cause) | Observed person- years(all death cause) | Acumulative HARRT cases | Acumulative HIV/AIDS cases | HAART ratio(%) |
1996 | 0 | 1 | 0 | 0.50 | 0.00 | 0 | 1 | 0 |
1997 | 1 | 3 | 0 | 2.50 | 0.00 | 0 | 4 | 0 |
1998 | 4 | 0 | 0 | 4.00 | 0.00 | 0 | 4 | 0 |
1999 | 4 | 0 | 0 | 4.00 | 0.00 | 0 | 4 | 0 |
2000 | 4 | 2 | 0 | 5.00 | 0.00 | 0 | 6 | 0 |
2001 | 6 | 7 | 2 | 8.50 | 23.53 | 0 | 13 | 0 |
2002 | 11 | 20 | 0 | 21.00 | 0.00 | 0 | 33 | 0 |
2003 | 31 | 24 | 0 | 43.00 | 0.00 | 0 | 57 | 0 |
2004 | 55 | 103 | 2 | 105.50 | 1.90 | 0 | 160 | 0 |
2005 | 156 | 194 | 11 | 247.50 | 4.44 | 1 | 354 | 0.28 |
2006 | 339 | 197 | 19 | 428.00 | 4.44 | 12 | 551 | 2.18 |
2007 | 517 | 254 | 67 | 610.50 | 10.97 | 45 | 805 | 5.59 |
2008 | 704 | 333 | 107 | 817.00 | 13.10 | 124 | 1138 | 10.90 |
2009 | 930 | 418 | 145 | 1066.50 | 13.60 | 265 | 1556 | 17.03 |
2010 | 1203 | 451 | 168 | 1344.50 | 12.50 | 411 | 2007 | 20.48 |
2011 | 1486 | 607 | 237 | 1671.00 | 14.18 | 698 | 2614 | 26.70 |
2012 | 1856 | 774 | 289 | 2098.50 | 13.77 | 1120 | 3388 | 33.06 |
2013 | 2341 | 1131 | 304 | 2754.50 | 11.04 | 1874 | 4519 | 41.47 |
2014 | 3168 | 1385 | 343 | 3689.00 | 9.30 | 2740 | 5904 | 46.41 |
2015 | 4210 | 1732 | 482 | 4835.00 | 9.97 | 4065 | 7636 | 53.23 |
2016 | 5460 | 2000 | 559 | 6180.50 | 9.04 | 5622 | 9636 | 58.34 |
2017 | 6901 | 2407 | 732 | 7738.50 | 9.46 | 7706 | 12043 | 63.99 |
2018 | 8576 | 2516 | 899 | 9384.50 | 9.58 | 9965 | 14559 | 68.45 |
2019 | 10193 | 2597 | 1324 | 10829.50 | 12.23 | 12449 | 17156 | 72.56 |
2020 | 11466 | 2297 | 1099 | 12065.00 | 9.11 | 14570 | 19453 | 74.90 |
total | — | 19453 | 6789 | 65954.00 | 10.29 | | | |
Survival time and cumulative survival rate The average survival time of the subjects was 10.521 years ( 95% CI : 9.60 ~ 10.81 ), the survival time M = 8.33 years ( 95% CI : 7.97 ~ 8.70 ), and the cumulative survival rates of the 1st, 10th, 20th and 24th years were 0.82,0.45,0.18 and 0.09, respectively. The cumulative survival rate gradually decreased with the increase of survival time.
Analysis of influencing factors Univariate Cox regression analysis showed that the survival time of the subjects was related to gender, occupation, age at diagnosis of HIV positive, marriage, ethnic minority category, education level, route of infection, first CD4 + T lymphocyte count, HAART and other factors ( P0.05 ), and was related to gender, age at diagnosis of HIV positive, marriage, ethnic minority category, education level, route of transmission, first CD4 + T lymphocyte count ( CD4 ), HAART ( P < 0.05 ). The risk of death in women was 0.77 times higher than that in men ( 95% CI : 0.73–0.82 ). The older the age at diagnosis of HIV positive, the higher the risk of death. The risk of death in the 20-, 40-, and 60-year-old groups was 1.47 times ( 95% CI : 1.10–1.57 ), 2.10 times ( 95% CI : 1.74–2.52 ), and 2.95 times ( 95% CI : 2.44–3.57 ) higher than that in the < 20-year-old group. The risk of death in married or cohabiting, divorced or widowed group was 0.91 times ( 95% CI : 0.84–0.98 ) and 0.88 times ( 95% CI : 0.81–0.95 ) higher than that in unmarried group. Compared with the Buyi ethnic minority, the mortality risk of the Dong ethnic minority was 0.74 times ( 95% CI : 0.69–0.80 ), the mortality risk of the Miao ethnic minority was 0.79 times ( 95% CI : 0.74–0.84 ), the mortality risk of the Tujia ethnic minority was 0.73 times ( 95% CI : 0.66–0.80 ), and the mortality risk of the Yi ethnic minority was 0.72 times ( 95% CI : 0.64–0.81 ). With the increase of education level, the risk of death decreased. The risk of death in junior high school education group, high school education group and college education group was 0.82 times ( 95% CI : 0.75 ~ 0.89 ), 0.81 times ( 95% CI : 0.71 ~ 0.92 ) and 0.52 times ( 95% CI : 0.43 ~ 0.62 ) higher than that in illiterate group. Compared with injection drug use infection, the risk of death in heterosexual infection group was 1.33 times ( 95% CI : 1.21–1.47 ), and the risk of death in homosexual infection group was 0.76 times ( 95% CI : 0.62–0.92 ). The higher the first CD4 count, the lower the risk of death. The risk of death in the 200 ~, 350 ~ and 500 ~ / µl groups was 0.52 times ( 95% CI : 0.48 ~ 0.55 ), 0.44 times ( 95% CI : 0.41 ~ 0.48 ) and 0.40 times ( 95% CI : 0.36 ~ 0.44 ) higher than that in the < 200 / µl group, respectively. The risk of death without CD4 was 1.44 times ( 95% CI : 1.34 ~ 1.55 ) higher than that in the < 200 / µl group. The risk of death in the HAART group was 0.13 times higher than that in the non-HAART group ( 95% CI : 0.13–0.14 ). As shown in Table 2.
Table 2
HIV / AIDS mortality and HAART among ethnic minorities in Guizhou Province, 1996–2020
Variable | Observation People | | Death Count | | Univariate Analysis | | Multivariate Analysis |
| Case | Constituent Ratio (%) | | Case | Constituent Ratio (%) | | HR (95% CI ) | P | | aHR (95% CI ) | P |
Gender | | | | | | | | | | | |
Male | 13177 | 67.74 | | 4935 | 72.69 | | 1 | | | 1 | |
Female | 6276 | 32.26 | | 1854 | 27.31 | | 0.74(0.70ཞ0.78) | 0.000 | | 0.77(0.73ཞ0.82) | 0.000 |
Age at diagnosis ,years | | | | | | | | | | | |
0ཞ19 | 706 | 3.63 | | 150 | 2.21 | | 1 | | | 1 | |
20ཞ39 | 7548 | 38.80 | | 2217 | 32.66 | | 1.43(1.21ཞ1.68) | 0.000 | | 1.32(1.10ཞ1.57) | 0.002 |
40ཞ59 | 7009 | 36.03 | | 2345 | 34.54 | | 2.44(2.07ཞ2.88) | 0.000 | | 2.10(1.74ཞ2.52) | 0.000 |
60ཞ | 4190 | 21.54 | | 2077 | 30.59 | | 4.46(3.77ཞ5.27) | 0.000 | | 2.95(2.44ཞ3.57) | 0.000 |
Occupation | | | | | | | | | | | |
cadre staff | 401 | 2.06 | | 60 | 0.88 | | 1 | | | 1 | |
worker | 412 | 2.12 | | 122 | 1.80 | | 2.42(1.78ཞ3.30) | 0.000 | | 1.14(0.83ཞ1.57) | 0.415 |
Housework doers or unemployed personnel | 3222 | 16.56 | | 1062 | 15.64 | | 2.31(1.78ཞ3.00) | 0.000 | | 1.23(0.93ཞ1.61) | 0.143 |
Retired people | 403 | 2.07 | | 200 | 2.95 | | 5.60(4.20ཞ7.48) | 0.000 | | 1.25(0.92ཞ1.69) | 0.151 |
Farmer | 12835 | 65.98 | | 4731 | 69.69 | | 3.94(3.05ཞ5.08) | 0.000 | | 1.52(1.16ཞ1.99) | 0.003 |
Commercial service workers | 648 | 3.33 | | 98 | 1.44 | | 1.16(0.84ཞ1.60) | 0.370 | | 1.00(0.72ཞ1.39) | 0.983 |
Others | 1003 | 5.16 | | 286 | 4.21 | | 2.04(1.54ཞ2.69) | 0.000 | | 1.06(0.80ཞ1.42) | 0.686 |
Unknown | 529 | 2.72 | | 230 | 3.39 | | 3.03(2.28ཞ4.03) | 0.000 | | 1.22(0.91ཞ1.65) | 0.185 |
marital status | | | | | | | | | | | |
Non-married | 4484 | 23.05 | | 1374 | 20.24 | | 1 | | | 1 | |
Married or cohabitation | 7725 | 39.71 | | 2524 | 37.18 | | 1.27(1.19ཞ1.35) | 0.000 | | 0.91(0.84ཞ0.98) | 0.014 |
Divorce or widowhood | 7195 | 36.99 | | 2853 | 42.02 | | 1.66(1.55ཞ1.77) | 0.000 | | 0.88(0.81ཞ0.95) | 0.001 |
Unknown | 49 | 0.25 | | 38 | 0.56 | | 4.12(2.98ཞ5.69) | 0.000 | | 1.17(0.84ཞ1.63) | 0.346 |
Minority | | | | | | | | | | | |
Buyi | 4974 | 25.57 | | 1888 | 27.81 | | 1 | | | 1 | |
Dong | 3267 | 16.79 | | 1145 | 16.87 | | 0.78(0.72ཞ0.84) | 0.000 | | 0.74(0.69ཞ0.80) | 0.000 |
Miao | 5233 | 26.90 | | 1784 | 26.28 | | 0.81(0.76ཞ0.87) | 0.000 | | 0.79(0.74ཞ0.84) | 0.000 |
Shui | 1718 | 8.83 | | 706 | 10.40 | | 1.08(0.99ཞ1.18) | 0.086 | | 1.04(0.95ཞ1.13) | 0.415 |
Tujia | 1659 | 8.53 | | 535 | 7.88 | | 0.63(0.57ཞ0.70) | 0.000 | | 0.73(0.66ཞ0.80) | 0.000 |
Yi | 994 | 5.11 | | 315 | 4.64 | | 0.77(0.68ཞ0.86) | 0.000 | | 0.72(0.64ཞ0.81) | 0.000 |
Others | 1608 | 8.27 | | 416 | 6.13 | | 0.57(0.51ཞ0.63) | 0.000 | | 0.62(0.56ཞ0.69) | 0.000 |
Education level | | | | | | | | | | | |
Illiteracy | 2681 | 13.78 | | 1103 | 16.25 | | 1 | | | 1 | |
Primary school | 7361 | 37.84 | | 2945 | 43.38 | | 0.90(0.84ཞ0.96) | 0.002 | | 0.94(0.88ཞ1.01) | 0.115 |
Middle school | 6301 | 32.39 | | 2138 | 31.49 | | 0.58(0.54ཞ0.62) | 0.000 | | 0.82(0.75ཞ0.89) | 0.000 |
High school/ Special Secondary School | 1575 | 8.10 | | 419 | 6.17 | | 0.43(0.38ཞ0.48) | 0.000 | | 0.81(0.71ཞ0.92) | 0.001 |
Junior college or above | 1523 | 7.83 | | 180 | 2.65 | | 0.19(0.16ཞ0.22) | 0.000 | | 0.52(0.43ཞ0.62) | 0.000 |
Unknown | 12 | 0.06 | | 4 | 0.06 | | 1.05(0.39ཞ2.81) | 0.920 | | 1.42(0.53ཞ3.80) | 0.486 |
CD4 + T cell counts (/µl) | | | | | | | | | | | |
0ཞ199 | 5772 | 29.67 | | 1956 | 28.81 | | 1 | | | 1 | |
200ཞ349 | 5371 | 27.61 | | 1106 | 16.29 | | 0.53(0.49ཞ0.57) | 0.000 | | 0.52(0.48ཞ0.55) | 0.000 |
350ཞ499 | 3347 | 17.21 | | 752 | 11.08 | | 0.52(0.48ཞ0.56) | 0.000 | | 0.44(0.41ཞ0.48) | 0.000 |
500ཞ | 2230 | 11.46 | | 524 | 7.72 | | 0.50(0.45ཞ0.55) | 0.000 | | 0.40(0.36ཞ0.44) | 0.000 |
Not detect | 2733 | 14.05 | | 2451 | 36.10 | | 6.16(5.80ཞ6.55) | 0.000 | | 1.44(1.34ཞ1.55) | 0.000 |
Infection route | | | | | | | | | | | |
Drug injection | 1111 | 5.71 | | 712 | 10.49 | | 1 | | | 1 | |
Heterosexual transmission | 16816 | 86.44 | | 5810 | 85.58 | | 0.99(0.91ཞ1.07) | 0.707 | | 1.33(1.21ཞ1.47) | 0.000 |
homosexual transmission | 1251 | 6.43 | | 133 | 1.96 | | 0.23(0.19ཞ0.28) | 0.000 | | 0.76(0.62ཞ0.92) | 0.005 |
Unknown | 275 | 1.41 | | 134 | 1.97 | | 1.11(0.92ཞ1.34) | 0.275 | | 1.36(1.11ཞ1.65) | 0.002 |
Antiviral treatment | | | | | | | | | | | |
No | 4648 | 23.89 | | 4177 | 61.53 | | 1 | | | 1 | |
Yes | 14805 | 76.11 | | 2612 | 38.47 | | 0.11(0.10ཞ0.11) | 0.000 | | 0.13(0.13ཞ0.14) | 0.000 |