Future Challenges for Changes in the Disease Burden of Inpatients Living With HIV in China: a Predictive Study
Authors: Shuai Yong , Nie Jingmin , Huang Yinqiu , Chen Yaokai 
Published: May 2021

Abstract
Objective: In China, the widespread use of Combination Antiretroviral Therapy(cART) has significantly improved the prognosis and quality of life in people living with HIV(PLWH). However, some PLWH still got worse and were hospitalized for some reasons, including AIDS-Defining Diseases(AD, such as opportunistic infections and AIDS-related Malignancies), Non-AIDS-Defining Diseases (NAD, such as non-AIDS-defining Malignancies and metabolic syndrome). At present, the age and disease of inpatients living with HIV(ILWH) are undergoing some significant changes. For example, the average age of ILWH is gradually increasing, the proportions of ILWH with NAD in all age groups are increasing, and the proportion of ILWH suffering from multiple types of NAD is increasing, which will have a greater impact to both ILWH and infectious disease hospitals. We aim to predict the changes in ILWH in the next 10 years, analyze the impact of such changes on ILWH and infectious disease hospitals in China, and propose corresponding countermeasures. Methods: We have established a prediction model based on Artificial Neural Network and Time series, using 12618 data of ILWH admitted to Chongqing Public Health Medical Center during 2010-2020, to predict the age of ILWH, the proportion of AD and NAD, the proportion of multiple types of NAD, and the proportion of NAD occurrences among various age groups from 2021 to 2030.Results: Our model shows that the average age of ILWH has risen from 43.8 years in 2010 to 57.6 years in 2030, and the increase in the age of women is greater than that of men. The number of ILWH in different age groups has changed significantly. Among them, the proportion of ILWH under 50 years old has gradually decreased, and the proportion of ILWH over 50 years old has gradually raised. By 2030, the proportion of inpatients over 50 years old will be close to 80%. The proportion of fatal opportunistic infections among ILWH has decreased year by year, and the most common diseases are tuberculosis-related diseases. The proportions of ILWH with only AD or NAD have gradually decreased, and the proportion of ILWH with both AD and NAD has increased year by year. It is estimated that the proportion of all ILWH with both AD and NAD will exceed 80% by 2030. Among all kinds of diseases in NAD, metabolic syndrome will have the highest rate of increase. By 2030, it will account for 16% in all ILWH. The proportion of hepatobiliary and pancreatic system diseases and blood system diseases in NAD will gradually decrease, while the proportion of metabolic syndrome, kidney disease, gastrointestinal disease, non-AIDS defining malignancies(NADM), bone disease and neurological diseases in NAD will gradually increase. The proportion of ILWH with NAD in all age groups will increase significantly after 10 years. Among them, the proportion of ILWH with NAD in 50-60 years old will be more than 80%, and among the ILWH under 30 years old, the proportion of ILWH suffering from NAD will increase to 69.6%. The proportion of ILWH without NAD or only 1 NAD will decrease, while the proportion of ILWH with 3 or more NAD will rise sharply. The proportion of ILWH with 1 type of NAD will drop to 12.6%, while the proportion of ILWH with 2 types of NAD, and the proportion of ILWH with 3 or more types of NAD will increase greatly. Conclusions: Significant changes have took place in the disease burden of ILWH in China, including the aging, the increase in the proportion of ILWH with NAD, and the increase in the proportion of ILWH with multiple types of NAD. These changes mean that in the next 10 years, the diagnosis, treatment and care of ILWH, as well as the development and construction of infectious disease hospitals will all face new challenges. This finding is based on a large number of long-term ILWH data in Chongqing, China, so we can consider that our research strategy can be promoted in China to improve the cure rate and quality of life in ILWH.