title: Epidemiological and mortality analysis of older adults with HIV in eastern China.
abstract: OBJECTIVE
  The aims of this study were to systematically review epidemiological characteristics in older people living with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) (PLWHA) in low endemic areas of the People's Republic of China, analyze the causes of death and mortality, and provide a basis for targeted prevention in these populations.
  
  
  METHODS
  Nine counties representative of the distribution and epidemiological factors of the HIV epidemic in Zhejiang Province were selected, and data from 1,115 HIV-positive individuals, including 196 older people (≥50 years), who were confirmed as PLWHA from January 1, 2000 to December 31, 2012, were retrospectively analyzed.
  
  
  RESULTS
  The proportion of older PLWHA increased from 0% in 2000 to 22.45% in 2012. Sexual transmission was the main route, accounting for 82.65% of infections in this group. Compared with the younger group (range from 14 to 49 years old), the older group had significantly lower CD4+ cell counts (291.64 versus 363.63; P<0.001) when first diagnosed, and more of this group presented in the AIDS state with opportunistic infections (51.02% versus 34.06%; P<0.001). In the older group, 25 (12.76%) patients died directly of AIDS and 171 (87.24%) were censored, and in the younger group 50 (5.44%) patients died directly of AIDS and 869 (94.56%) were censored. Estimated survival time since HIV diagnosis in the older group was 11.54±0.49 years (95% confidence interval [CI] 10.59-12.50), while in the younger group it was 13.85±0.46 years (95% CI 12.94-14.76), the log rank (Mantel-Cox) test gave a chi-square value of 3.83, and there was significant difference between the groups (P<0.05).
  
  
  CONCLUSIONS
  The number of older PLWHA increased steadily over the study period in low HIV endemic provinces of a developing country. Later discovery and preexisting disease perhaps contributed to a shorter estimated survival time for older PLWHA and higher mortality.
authors.affiliation: State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital of Zhejiang University, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China ; Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, People's Republic of China.
authors.forename: Tiansheng
authors.initials: T
authors.lastname: Xie
authors.forename: Nanping
authors.initials: N
authors.lastname: Wu
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D002681:China / Q000453:epidemiology; D016001:Confidence Intervals; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012189:Retrospective Studies; D016019:Survival Analysis
keywords: AIDS; HIV; People’s Republic of China; older people; survival analysis