Objective To analyze the disease burden and  changing trends of human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) in China from 1990 to 2023, and to predict future trends.

Methods Based on the Global Burden of Disease 2023 database, incidence, prevalence, mortality, disability-adjusted life years (DALY) and their age-standardized rates(ASRs) were used to analyze the disease burden of HIV/AIDS in China from 1990 to 2023. Trends were evaluated using Joinpoint regression, and disease burden from 2024 to 2035 was projected using a Bayesian age-period-cohort (BAPC) model.

Results From 1990 to 2023, the overall burden of HIV/AIDS in China increased markedly. Incidence rose from 0.90 per 100,000 to 2.70 per 100,000, prevalence from 5.37 per 100,000 to 45.74 per 100,000, mortality from 0.17 per 100,000 to 2.51 per 100,000, and DALY from 8.36 per 100,000 person-years to 109.30 per 100,000 person-years. Across all years, ASRs were consistently higher in males than in females. Incidence increased with age, prevalence peaked among older adults, and DALY rates were highest in middle-aged populations. Joinpoint regression indicated overall increasing trends in age-standardized incidence rates (ASIR) [average annual percentage change (AAPC)=3.64%, 95%CI (3.42%, 3.82%)], age-standardized prevalence rates (ASPR) [AAPC=6.28%, 95%CI (6.22%, 6.34%)], age-standardized mortality rates (ASMR) [AAPC=7.90%, 95%CI (7.71%, 8.14%)], and age-standardized DALY rates (ASDR) [AAPC=7.90%, 95%CI (7.73%, 8.11%)] from 1990 to 2023 (P < 0.05). BAPC projections suggest that from 2024 to 2035, ASIR in the overall population will continue to increase, while ASPR, ASMR, and ASDR will decline.

Conclusion The HIV/AIDS burden in China increased substantially from 1990 to 2023, with pronounced sex- and age-related disparities. The ASIR of HIV/AIDS in China is predicted to continue rising in the future. Therefore, further strengthened prevention and control of HIV/AIDS transmission is warranted, with targeted strategies tailored to the characteristics of different sex and age groups.

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