Mortality trends and epidemiological characteristics among people living with HIV in Huangshi, China: a time-series analysis (2004–2024)

OBJECTIVE: To analyze the epidemiological characteristics and dynamic trends of people living with HIV (PLWH) in Huangshi between 2004 and 2024, thereby providing a scientific basis for the optimization of regional HIV prevention and control strategies. METHODS: Surveillance data of PLWH from Huangshi during the period 2004-2024 were collected. Descriptive epidemiology methods were employed to examine the temporal distribution, demographic features (including age, sex, marital status), transmission routes, clinical manifestations, and mortality patterns. A Cochrane-Armitage trend test was utilized to assess changes in gender composition, while SPSS 27 was leveraged to establish a time-series model based on exponential smoothing techniques to forecast future mortality counts. RESULTS: The number of PLWH in Huangshi exhibited a marked increase post-2009, peaking in 2015, followed by a significant decline from 2020 onward. Key structural shifts were observed: (1) among reported cases, the 51-80 age group accounted for the highest proportion (representing the age composition within the infected population, rather than age-specific incidence in the general population). Male cases showed a pronounced upward trend, whereas female cases demonstrated a gradual decrease. (2) Sexual transmission constituted the predominant mode, accounting for 95.02% of cases, with heterosexual transmission highly concentrated among males aged 51-70 years. (3) The primary opportunistic infections were persistent fever and Pneumocystis pneumonia. Post-2013, mortality rates escalated significantly, yet over one-third of deaths were attributed to causes unrelated to HIV, with cardiovascular diseases and malignancies ranking as major contributors, reflecting a shift toward chronic comorbidity management. (4) Time-series modeling predicted a gradual decline in the estimated number of HIV-related deaths for the years 2025-2028. CONCLUSION: HIV transmission in Huangshi has evolved into a stage characterized by sexual transmission as the primary route, with a notable increase in the disease burden among older adults and males. The focus is now transitioning from HIV-related mortality to the management of chronic comorbidities. Future HIV prevention efforts in the city should adopt comprehensive strategies, including targeted interventions and enhanced surveillance for males-particularly older males-strengthened treatment and prevention measures, and integrated approaches to chronic disease management to address the evolving epidemiological landscape.