Evolution of death trends and influencing factors of people living with HIV from 2003 to 2025 in Huangshi, China

This study aimed to analyze mortality trends, causes of death, and key prognostic factors among people living with HIV (PLWH) receiving antiretroviral therapy (ART) in Huangshi, Hubei Province, from 2003 to 2025, to inform the optimization of clinical management and public health policy. A retrospective cohort analysis was conducted, collecting demographic characteristics, WHO clinical stage, CD4 counts, initial ART Regimen, and follow-up information. The primary outcome was all-cause mortality. First, a univariable Cox regression analysis was performed. The proportional hazards assumption was then tested using the Schoenfeld residual test. If time dependency was detected, a time-stratified Cox model was constructed. Kaplan-Meier (KM) survival curves were used for visual presentation of survival patterns across different groups. After screening, 2,494 ART-treated PLWH were included, of whom 671 died. Mortality peaked in 2017 and 2022, followed by a subsequent decline. The leading causes of death were opportunistic infections and cardiovascular diseases. Univariate analysis indicated that age, sex, marital status, transmission route, presence of AIDS-related symptoms, WHO clinical stage, CD4 count, and initial ART regimen were associated with mortality risk. In the time-stratified Cox model, age, transmission route, AIDS-related symptoms, baseline CD4 count, recent CD4 count, and initial ART regimen were significantly associated with mortality risk (P < 0.05). KM survival curves demonstrated lower survival rates among older individuals, those infected via heterosexual transmission, patients with clinical symptoms, those with low CD4 levels, and NVP-based regimen groups. In the ART era, mortality among PLWH is influenced by multiple factors. Opportunistic infections remain the primary cause of death, while the rise in cardiovascular disease reflects the evolving chronic disease profile of HIV. Enhancing early diagnosis, immune monitoring, and opportunistic infection prevention, and integrating chronic disease management are pivotal for improving survival and quality of life.