Evolution of HIV Epidemic and Emerging Challenges — China, 1989–2023

Chang Cai^1,2; Houlin Tang^1,2; Dongmin Li^1,2; Qianqian Qin^1,2; Fangfang Chen^1,2; Yichen Jin^1,2; Fan Lyu^1,2,# 

1Division of Epidemiology, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.

2National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China

^# Corresponding author: Fan Lyu, fanlv@chinaaids.cn.

This study aimed to provide a comprehensive analysis of the human immunodeficiency virus (HIV) epidemiological landscape in China through historical review and current assessment. Data were extracted from China's HIV/AIDS Comprehensive Response Information Management System (CRIMS). Transmission patterns across different phases were visualized using stacked area charts. Geographical correlations between transmission routes were analyzed using scatter plots and Pearson correlation coefficients. The extent and trends of HIV spread among the general population were evaluated using Venn diagrams and Cochran-Armitage tests. The HIV epidemic in China evolved through four distinct phases: injection drug user (IDU) dominated (1989–1994), former plasma donor (FPD) outbreak (1995–2005), sexual transmission dominance (2006–2014), and general population spread (2015–present). A strong correlation was observed between provinces reporting high numbers of IDU cases and those with elevated heterosexual transmission (r=0.88, P<0.001). Between 2015 and 2023, 393,926 cases were identified among the general population through non-marital and non-commercial heterosexual contact (NMNCHC). The proportion of general population cases among heterosexual transmissions increased significantly from 46.2% to 55.7% (Z=42.7, P<0.001). The significant spread of HIV into the general population necessitates the development of targeted prevention strategies for both high-risk and general populations to address emerging epidemiological challenges.

艾滋病病毒流行史及新挑战 —中国，1989–2023年

蔡畅^1,2；汤后林^1,2；李东民^1,2；秦倩倩^1,2；陈方方^1,2；金怡晨^1,2；吕繁^1,2,# 

1.中国疾病预防控制中心性病艾滋病预防控制中心流行病学室，北京，中国。

2.传染病溯源预警与智能决策全国重点实验室，中国疾病预防控制中心性病艾滋病预防控制中心，北京，中国

^# 通讯作者: 吕繁，fanlv@chinaaids.cn。

本研究旨在通过历史回顾和现状评估，对中国人类免疫缺陷病毒（HIV）的流行病学状况进行全面分析。数据提取自中国艾滋病综合防治信息管理系统（CRIMS）。用堆积面积图对不同阶段的传播模式进行可视化呈现。运用散点图和皮尔逊相关系数分析传播途径地域分布之间的相关性。通过韦恩图和Cochran-Armitage检验评估HIV在一般人群中传播的程度和趋势。中国的艾滋病病毒流行经历了四个不同阶段：以注射吸毒者（IDU）为主（1989—1994年）、既往有偿供血者（FPD）疫情暴发（1995—2005年）、性传播占主导（2006—2017年）以及在一般人群中传播（2015年至今）。报告注射吸毒感染者越多的省份报告异性性传播感染者也越多（r=0.88，P<0.001）。2015年至2023年期间，通过非婚非商业异性性接触（NMNCHC）感染的一般人群共393,926例。在异性性传播感染者中，一般人群所占比例从46.2%上升至55.7%（Z=42.7，P<0.001）。HIV在一般人群中扩散明显，需要分别针对高危人群和一般人群制定防控策略，以应对新出现的流行病学挑战。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2024.251

National and Regional Molecular Epidemiology of HIV-1 — China, 2004–2023

Dong Wang¹; Yi Feng¹; Jingjing Hao¹; Hongping Hu¹; Fangyuan Li¹; Jialu Li¹; Yuhua Ruan¹; Lingjie Liao¹; Jing Hu¹; Chang Song¹; Yiming Shao¹; Hui Xing^1,#

1. National Center for AIDS/STD Control and Prevention (NCAIDS), Chinese Center for Disease Control and Prevention (China CDC), State Key Laboratory of Infectious Disease Prevention and Control (SKLID), Beijing, China.

^# Corresponding author: Hui Xing, xingh@chinaaids.cn.

The genetic diversity of human immunodeficiency virus (HIV)-1 subtypes significantly influences the effectiveness of diagnostic tools, antiretroviral therapy (ART), and vaccine development. This study aimed to assess the regional and national prevalence of HIV-1 subtypes and recombinants in China between 2004 and 2023 using pol gene segment analysis. This study analyzed annual HIV/AIDS reports and pol gene segment sequences from all Chinese provinces between 2004 and 2023. The distribution of HIV-1 subtypes and recombinants across China and within its regions was estimated by multiplying the proportion of each subtype, circulating recombinant form (CRF), and unique recombinant form (URF) in each province by the corresponding number of reported HIV infections. Analysis of 94,476 pol gene segments from 31 provinces revealed that CRF01_AE strain accounted for 32.1% of HIV-1 infections during 2004–2023, while CRF07_BC lineage represented 39.1%. CRF08_BC strain contributed 9.2%, followed by subtype B (8.7%) and CRF55_01B (2.4%). Other CRFs collectively comprised 6.0% of infections, while URFs and other subtypes accounted for 1.3% and 1.1%, respectively. The study revealed significant regional variations and temporal changes in the proportions of HIV-1 CRFs, subtypes, and URFs across China, emphasizing the importance of continued surveillance of strain distribution patterns.

HIV-1毒株分布特征和变化趋势 —中国，2004–2023年

王栋¹；冯毅¹；郝静静¹；胡红萍¹；李方园¹；李佳璐¹；阮玉华¹；廖玲洁¹；胡婧¹；宋畅¹；邵一鸣¹；邢辉^1，#

1. 中国疾病预防控制中心性病艾滋病预防控制中心，传染病预防控制国家重点实验室，北京，中国。

^# 通讯作者: 邢辉, xingh@chinaaids.cn。

1型人类免疫缺陷病毒（HIV）的遗传多样性极大地影响了诊断试剂、抗逆转录病毒治疗（ART）和疫苗的开发。本研究旨在利用pol基因片段分析我国2004年至2023年期间HIV-1各亚型和重组株在全国和地区的分布特征。本研究分析了2004年至2023年期间我国所有省份的艾滋病年度报告和pol基因片段序列。将各亚型毒株、流行重组型毒株（CRF）和独特重组型毒株（URF）在各省所占的比例乘以相应的艾滋病病毒感染者报告数，从而估算出全国及各地区HIV-1亚型和重组型的分布情况。对来自31个省份的94,476个pol基因片段进行分析后发现，2004-2023年期间，CRF01_AE株占HIV-1感染病例的32.1%，而CRF07_BC株系占39.1%。CRF08_BC株占9.2%，第二和第三为B亚型（8.7%）和CRF55_01B（2.4%）。其他CRF共占感染病例的6.0%，而URF和其他亚型分别占1.3%和1.1%。本研究揭示了HIV-1 CRFs、亚型和URFs比例在我国的变化趋势和时空分布特征，表明了持续监测毒株分布特征的重要性。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2024.252

Survival of People Living with HIV/AIDS from Pre-ART Era to Treat-all Era — China, 1985–2022

Shi Wang¹; Houlin Tang¹; Decai Zhao¹; Chang Cai¹; Yichen Jin¹; QianQian Qin¹; Fangfang Chen¹; Liping Fei¹; Hehe Zhao¹; Zhongnian Yang ¹; Fan Lyu^1,2,#

1.National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.

2.National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.

^# Corresponding author: Fan Lyu, fanlv@chinaaids.cn.

A comprehensive analysis of nationwide survival trends for people living with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS, PLWHA) from the initial reported case to present has not been conducted. This study evaluated the survival outcomes of PLWHA reported in China from 1985 to 2022. We analyzed data from PLWHA recorded in the National HIV/AIDS Comprehensive Response Information Management System from 1985 to 2022. Survival rates were calculated using Kaplan-Meier curves, and factors associated with survival time were analyzed using Cox proportional hazard models. Progressive relaxation of antiretroviral therapy initiation criteria led to significant improvements in survival rates across different diagnostic periods in China. The 1-year and 5-year cumulative survival rates increased from 85.2% and 66.1% in the 1985–2003 cohort to 91.1% and 81.4% in the 2016–2022 cohort. Cox proportional hazard analysis revealed elevated mortality risks among males, individuals aged ≥65 years, those with injection drug use or other transmission routes, hospital-tested patients, and those with lower CD4 counts at diagnosis or without treatment. Antiretroviral therapy has effectively reduced mortality risk among PLWHA in China. Future efforts should focus on expanding HIV testing to reduce the proportion of late diagnoses with lower CD4 counts and providing targeted, differentiated services for older populations to further decrease mortality risk among PLWHA.

从抗病毒治疗前时代到全员治疗时代艾滋病病毒感染者/艾滋病患者的生存状况 — 中国，1985-2022年

王实¹；汤后林 ¹；赵德才¹；蔡畅¹；金怡晨¹；秦倩倩¹；陈方方¹；费丽萍¹, 赵鹤鹤¹；杨忠念¹；吕繁^1,2,#

1. 中国疾病预防控制中心性病艾滋病预防控制中心, 北京，中国；

2. 传染病溯源预警与智能决策全国重点实验室，中国疾病预防控制中心性病艾滋病预防控制中心，北京，中国。

^# 通信作者：吕繁，fanlv@chinaaids.cn。

目前仍缺少从首次报告病例至今中国艾滋病病毒感染者/艾滋病患者（people living with HIV/AIDS, PLWHA）生存情况的最新数据。本研究评估了1985－2022年报告的PLWHA生存情况。利用1985－2022年中国艾滋病综合防治信息系统中报告PLWHA的数据资料进行分析，应用K-M法计算生存率，采用Cox比例风险模型分析生存时间的相关影响因素。随着国家接受免费抗病毒药物治疗标准放宽，我国不同诊断队列下PLWHA生存率显著提高。1985-2003队列人群1年累积生存率和5年累积生存率分别为85.2%和66.1%，2016-2022年队列人群1年累积生存率和5年累积生存率提高到91.1%和81.4%。Cox比例风险模型显示男性、诊断时年龄≥65岁、注射吸毒或其他传播途径、医院检测、诊断时处于低CD4计数水平或未治疗人群的死亡风险更高。抗病毒药物治疗对降低中国PLWHA死亡风险具有显著效果，未来应继续采取扩大HIV检测策略降低诊断时处于低CD4计数水平的人群比例，并对老年群体提供差异化精准服务从而进一步降低PLWHA死亡风险。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2024.253

An Index–Contact Paired Data Analysis on Sexual Contact Tracing Outcomes of HIV-Infected Individuals — Yunnan Province, China, 2022–2024

Wenjun Yan^1,&; Junli Huo^2,&; Xiaojing An^2,*; Qiongli Duan³; Yu Han²; Nengmei Huang³; Ting Tan⁴; Zhimin Yang²; Jing Han¹; Mengjie Han¹; Yuhua Shi^2,#; Jian Li^1,#

1. National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China;

2. Yunnan Center for Disease Control and Prevention, Kunming, Yunnan Province, China;

3. Center for Disease Control and Prevention in Honghe Hani and Yi Autonomous Prefecture, Mengzi City, Yunnan Province, China;

4. Kunming Medical University, Kunming, Yunnan Province, China.

^& Joint first authors.

# Corresponding author: Jian Li, jli@chinaaids.cn; Yuhua Shi, shiyuhua@yncdc.cn.

The objective of this study was to assess the impact of characteristics of HIV index cases and their sexual contacts on the effectiveness of contact tracing outcomes. In 2022-2024, an egocentric contact tracing survey was conducted to invite newly diagnosed HIV-infected individual as an index case to provide sexual contact information in Honghe Prefecture, Yunnan Province. Multivariate logistic regression models and multilevel logit models were employed to calculate adjusted odds ratio for factors associated with contact tracing outcomes. A total of 2,171 sexual contacts were reported by the 1,981 enrolled index cases. Among these contacts, 1,509 (69.5%) underwent HIV testing, and 317 (21.0% of those tested) were found to be HIV-positive. HIV testing uptake among sexual contacts was associated with having a higher education level and an employment status. The risk of HIV infection among contacts was elevated when the index case was female and detected through active testing protocols. Long-term sexual partnerships and inconsistent condom use showed an increased risk of HIV infection. The findings provide valuable insights into how index case characteristics impact the outcomes of contact tracing. The development of implementation for sexual contact tracing programs in China should take this into consideration.

HIV感染者性伴追踪结果的指示病例-接触者配对数据分析 — 云南省，中国，2022–2024年

严雯君^1,&；霍俊丽^2,&；安晓静^2,&；端琼丽³；韩瑜²；黄能梅³；谭婷⁴；杨志敏²；韩晶¹；韩孟杰¹；施玉华^2,#；李健^1,#

¹中国疾病预防控制中心性病艾滋病预防控制中心，北京，中国；

²云南省疾病预防控制中心，昆明市，云南省，中国；

³红河州疾病预防控制中心，蒙自市，云南省，中国；

⁴昆明医科大学，昆明市，云南省，中国。

^& 共同第一作者。

^# 通信作者：李健，jli@chinaaids.cn；施玉华，shiyuhua@yncdc.cn。

本研究旨在了解HIV指示病例及其性伴特征对HIV接触者溯源结果的影响。2022-2024年在云南省红河州，招募每位新报告的HIV感染者作为指示病例参与一项以自我为中心的接触者追踪调查。采用多因素Logistic回归模型和多层次Logit模型计算与接触者追踪结果相关因素的校正比值比。1,981名HIV指示病例共报告了2,171名性伴。其中，1,509名（69.5%）接受了HIV检测，317名（占检测者的21.0%）检测阳性。性伴的HIV检测率与其较高的教育水平和就业状况相关。当指示病例为女性、通过主动检测发现时，性伴感染HIV的风险增加。长期性伴侣关系及不持续使用安全套与HIV感染风险增加相关。研究结果可为理解指示病例特征如何影响接触者追踪结果提供重要参考。中国在实施性伴追踪项目时应考虑这些因素，以提高溯源效果。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2024.254

Study on the Technical Parameters for Estimating HIV-1 Incidence by Using a Recombinant Antigen-based Capture Enzyme Immunoassay — China

Wenli Liang^1,&; Jibao Wang^2,&; Hongxia Yan^3,*; Xinhui Zhang⁴; Dorjiwangmo⁵; Dongmin Li¹; Xing Duan²; Hao Wu³; Yinyin Wang⁶; Li Bai⁷; Jian Sun⁵; Mengjie Han¹; Yikui Wang²; Bin Su³; Min Wang⁸; Tashibazong⁵; Wenge Xing¹; Cui Zhang¹; Ruijuan Qiao^7,#; Maofeng Qiu^1,#

1. National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.

2. Department of AIDS/STD Control and Prevention, Dehong Center for Disease Control and Prevention, Mangshi County, Dehong Dai and Jingpo Autonomous Prefecture, Yunnan Province China.

3. Beijing Key Laboratory for HIV/AIDS Research, Beijing Youan Hospital, Capital Medical University, Beijing, China

4. Institute of Infectious Diseases Prevention and Treatment, Guizhou Provincial Center for Disease Control and Prevention, Guiyang City, Guizhou Province, China

5. Department of AIDS Control and Prevention, Xizang Autonomous Region Center for Disease Control and Prevention, Lasa City, Xizang Autonomous Region, China

6. Experimental Center, Guizhou Provincial Center for Disease Control and Prevention, Guiyang City, Guizhou Province, China

7. Department of AIDS Control and Prevention, Gansu Provincial Center for Disease Control and Prevention, Lanzhou City, Gansu Province, China

8. Laboratory Department, Liupanshui Center for Disease Control and Prevention, Zhongshan City, Guangdong Province, China.

^& Joint first authors.

# Corresponding author: Ruijuan Qiao, qiaoruijuan@outlook.com; Maofeng Qiu, qiumf@chinaaids.cn.

A novel optimized recombinant antigen-based capture enzyme immunoassay (RAg-CEIA) was developed to determine technical parameters for estimating human immunodeficiency virus type 1 (HIV-1) incidence in China. We employed orthogonal experimental design to optimize RAg-CEIA by adjusting raw material dilution ratios. The assay was used to measure normalized optical density (ODn) values in 171 longitudinal plasma specimens from 51 HIV-1 seroconverting individuals, plotted against estimated days post-seroconversion. We determined the optimal ODn threshold value for differentiating recent from long-term infections and calculated the mean duration of recent infection (MDRI) for incidence estimation. The false recent rate (FRR) was determined using 481 HIV-1 antibody-positive specimens with infection durations exceeding twice the MDRI. Optimal RAg-CEIA parameters were established with a raw material dilution ratio of 1/12 for calibrator preparation and an enzyme conjugate titer of 1:1200. ODn values demonstrated consistent temporal increases across HIV-1 seroconverting individuals, though with notable kinetic heterogeneity in individual responses. The optimal ODn threshold value of 0.8 for distinguishing recent from long-term infections corresponded to an MDRI of 205 days and an FRR of 4.78%. The optimized RAg-CEIA effectively differentiates recent from long-term HIV-1 infections at the population level, enabling reliable HIV-1 incidence estimation in China.

.

重组抗原捕获酶联免疫试验用于估算HIV-1新发感染率所需的技术参数研究 — 中国

梁雯丽^1,&；王继宝^2,&；闫红霞^3,&；张信辉⁴；多吉旺姆⁵；李东民¹；段星²；吴昊³；王寅寅⁶；白莉⁷；孙剑⁵；韩孟杰¹；王译葵²；粟斌³；王敏⁸；扎西巴宗⁵；邢文革¹；张翠¹；乔瑞娟^7,#；邱茂锋^1,#

¹传染病溯源预警与智能决策全国重点实验室，中国疾病预防控制中心性病艾滋病预防控制中心，北京，中国；

²德宏傣族景颇族自治州疾病预防控制中心艾滋病性病预防控制科，德宏州芒市，云南省，中国；

³首都医科大学附属北京佑安医院艾滋病研究北京市重点实验室，北京,中国；

⁴贵州省疾病预防控制中心传染病防治研究所，贵阳市，贵州省，中国；

⁵西藏自治区疾病预防控制中心艾滋病防治所，拉萨市，西藏自治区，中国；

⁶贵州省疾病预防控制中心实验中心，贵阳市，贵州省， 中国；

⁷甘肃省疾病预防控制中心艾滋病预防控制所，兰州市，甘肃省，中国；

⁸六盘水市疾病预防控制中心检验科，六盘水市，贵州省，中国。

^& 共同第一作者

^# 通信作者：邱茂锋, qiumf@chinaaids.cn；乔瑞娟, qiaoruijuan@outlook.com。

对一种新型重组抗原捕获酶联免疫试验（recombinant antigen-based capture enzyme immunoassay，RAg-CEIA）进行优化，并测算将它用于在中国估算人免疫缺陷病毒1型（human immunodeficiency virus type 1, HIV-1）新发感染率所需的技术参数。采用正交试验设计，通过调整原材料稀释比例优化RAg-CEIA。利用优化后的方法检测来自51名HIV-1血清阳转个体的171份系列血浆样本的标准化光密度（normalized optical density, ODn）值，将ODn值与估算血清阳转天数相对应作图，计算区分新近感染与长期感染的最佳ODn阈值和估算新发感染率的平均新发感染期（mean duration of recent infection, MDRI）。使用481份感染时间超过两倍MDRI的HIV-1抗体阳性样本计算假新近感染率（false recent rate, FRR）。确定了RAg-CEIA的最佳参数，即制备校准品的原材料稀释比例为1/12，酶标抗原滴度为1:1200。ODn值在HIV-1血清阳转个体中呈现出随时间增加的趋势，个体反应的动力学异质性较为显著。区分新近感染与长期感染的最佳ODn阈值为0.8，相应的MDRI为205天，FRR为4.78%。优化后的RAg-CEIA能在人群水平有效区分HIV-1新近感染与长期感染，能在中国进行可靠的HIV-1新发感染率估算。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2024.255