| Background In the mid-1990s in China, many former comercial plasma donors (FPDs) were found HIV positive due to illegal and unsafe practices of plasma collection. Previous studies on the natural history of HIV infections among this population were based on seropositive HIV antibody results. But seropositivity testing would not have accounted for rapid progressors, or those who were not tested before, resulting in selection bias.Objectives This study sought to evaluate the trend of AIDS deaths and the impact of AIDS-related deaths on the local population. The study also investigated the natural history of HIV infection among FPDs, including median times of HIV survival, AIDS incubation and AIDS survival, respectively. Risk factors related to disease progression were investigated.Methods All death cases recorded between January 1995 and October 2007 were collected from seven administrative villages in Shangcai county of Henan province. When the cause of death was not clearly stated in the death certificate or hospital medical records, a house visit was conducted to collect further information about the deceased person. A cohort of HIV/AIDS FPDs was comprised of those that were suspected to have died an AIDS-related death, and FPDs with confirmed HIV/AIDS cases as found in HIV/AIDS case management system. The information collected included demographic information, date of AIDS diagnosis and death, and medical records. The start-point for this study was the date of HIV infection and the end-point was March 31,2008. AIDS incubation time and survival patterns were analyzed using Kaplan-Meier methods, survival profiles among different levels were compared with Log-rank testing, and related risk factors were analyzed using univariate factor and multiple factors Cox proportional hazard models.Results1. There were a total of 2,546 deaths in 7 villages, of which 521 (20.5%) were HIV/AIDS-related,525 (20.6%) were suspected AIDS deaths, and 1,500 (58.9%) were unrelated HIV/AIDS deaths. The proportion of deaths among people aged 30-49 years was less than 20% from 1995-1997, but increased to 21.5% in 1998, and reached 42.3% in 2002, followed by a decrease in succeeding years, reaching 25.5% in 2007. The age range 30-40 years old at time of death accounted for 59.7% and 59.8% of HIV/AIDS related deaths and HIV/AIDS suspected deaths, respectively. The overall mortality rate was 7%o from 1995 to 1999, and 14.9%o in 2002.2. By the end of the survey endpoint,2,569 HIV cases of former plasma donors were investiaged of which 2535 (98.7%) were AIDS patients and 983 (38.8%) deaths. This included 483 suspicious AIDS deaths. The proportion of rapid progressors was 7.8%.3. The median AIDS incubation time was 8.5-8.9 years, with an incidence rate of 11.7-12.0 cases/100 person-years. The Cox regression model showed age at HIV infection was significantly related to AIDS incubation. Compared with age of 15-29 at HIV infection, the hazard ratios of age groups 30-39,40-49, and more than 50 years were 1.23,1.43 and 1.49, respectively.4. The median survival time for HIV infection was 8.8-10.7 years, with the mortality rate at 6.9-8.3 cases/100 person-years. Cox regression model showed age at HIV infection was significantly related with HIV survival time. Compared with age of 15-29 at HIV infection, the hazard ratios of age groups 30-39,40-49, and more than 50 years were 1.16,1.37 and 1.74, respectively.5. The median survival time for AIDS cases was 1.2-2.0 years, with the mortality rate of 34.9-51.5 cases/100 person-years. Cox regression model showed age at HIV infection and AIDS incubation period were related with AIDS survival time. Compared with age range 15-29 at HIV infection, the hazard ratio of age of more than 50 years was 1.24. Compared with AIDS incubation time of less than 5 years, the hazard ratio of AIDS incubation time of more than 10 years was 0.45.Conclusion HIV/AIDS-related deaths and suspected HIV/AIDS-related deaths have led to a palpable rise in the surveyed villages' mortality rate, and after 2000 became the main causes of death. For HIV-infected former plasma donor,7.8% developed to AIDS in 5 years infection. The median AIDS incubation time was 8.8 years, median survival time for AIDS patients was 1.2 years, and median survival time for HIV infection was 9.8 years. Older age was a risk factor for developing AIDS and AIDS-related death. The risk f death increased for AIDS patients who were more than 50 years old at age of HIV infection. The risk to of death decreased for those who had longer than 10 years of AIDS incubation time.
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