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Background <p>Despite advancements in antiretroviral therapy, people living with HIV/AIDS (PLWHA) still experience elevated mortality risks compared to the general population. While ambient air pollution is increasingly recognized as a risk factor for mortality, cohort studies on the long-term effects of ambient nitrogen dioxide (NO<sub>2</sub>) exposure on PLWHA remain scarce.</p> Methods <p>This retrospective cohort study included all individuals diagnosed with HIV/AIDS in Hubei Province from 2008 to 2020. Cox proportional hazard models were employed to assess the association between long-term exposure to NO<sub>2</sub> and cause-specific mortality among PLWHA. Restricted cubic spline models characterized the concentration-response curves for NO<sub>2</sub> exposure and cause-specific mortality. We estimated the number of avoidable deaths and gained life expectancy if reached the World Health Organization’s Air Quality Guidelines level (WHO AQG level) of NO<sub>2</sub>.</p> Results <p>Long-term exposure to NO<sub>2</sub> was significantly associated with increased risks of non-accidental, AIDS-related deaths, and non-AIDS-related deaths among PLWHA. Each 1&#xa0;µg/m<sup>3</sup> increase in annual NO<sub>2</sub> concentration was linked to an excess risk of 1.44% [95% confidence interval (CI): 1.05, 1.82] for non-accidental deaths, and 2.72% (95% CI: 2.11, 3.34) for AIDS-related deaths, and 0.59% (95% CI: 0.10, 1.09) for non-AIDS-related deaths. Individuals aged over 65 years and those with lower initial CD4 + cell counts exhibited higher susceptibility to NO<sub>2</sub> exposure. If the WHO AQG level had been achieved, approximately 970 non-accidental deaths, 646 AIDS-related deaths, and 149 non-AIDS-related deaths could have been avoidable, respectively. The extended life expectancy of PLWHA aged between 20 and 24 years old was up to 4.19 years in 2020.</p> Conclusions <p>Long-term NO<sub>2</sub> exposure is associated with increased mortality risks among PLWHA. Implementing stringent air quality standards and targeted interventions for high-risk populations could mitigate the adverse health effects of NO<sub>2</sub> pollution, and extend the lives of PLWHA.</p>

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Reducing ambient nitrogen dioxide concentration could increase the life expectancy of people with HIV/AIDS: evidence from a population-based cohort study in China, 2008–2020

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  • 发表日期：

    2025年12月1日

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  • Wei Zhu,
  • Dingyuan Zhao,
  • Ming Cai,
  • Lianguo Ruan,
  • Heng Tang,
  • Faxue Zhang

摘要

Background

Despite advancements in antiretroviral therapy, people living with HIV/AIDS (PLWHA) still experience elevated mortality risks compared to the general population. While ambient air pollution is increasingly recognized as a risk factor for mortality, cohort studies on the long-term effects of ambient nitrogen dioxide (NO2) exposure on PLWHA remain scarce.

Methods

This retrospective cohort study included all individuals diagnosed with HIV/AIDS in Hubei Province from 2008 to 2020. Cox proportional hazard models were employed to assess the association between long-term exposure to NO2 and cause-specific mortality among PLWHA. Restricted cubic spline models characterized the concentration-response curves for NO2 exposure and cause-specific mortality. We estimated the number of avoidable deaths and gained life expectancy if reached the World Health Organization’s Air Quality Guidelines level (WHO AQG level) of NO2.

Results

Long-term exposure to NO2 was significantly associated with increased risks of non-accidental, AIDS-related deaths, and non-AIDS-related deaths among PLWHA. Each 1 µg/m3 increase in annual NO2 concentration was linked to an excess risk of 1.44% [95% confidence interval (CI): 1.05, 1.82] for non-accidental deaths, and 2.72% (95% CI: 2.11, 3.34) for AIDS-related deaths, and 0.59% (95% CI: 0.10, 1.09) for non-AIDS-related deaths. Individuals aged over 65 years and those with lower initial CD4 + cell counts exhibited higher susceptibility to NO2 exposure. If the WHO AQG level had been achieved, approximately 970 non-accidental deaths, 646 AIDS-related deaths, and 149 non-AIDS-related deaths could have been avoidable, respectively. The extended life expectancy of PLWHA aged between 20 and 24 years old was up to 4.19 years in 2020.

Conclusions

Long-term NO2 exposure is associated with increased mortality risks among PLWHA. Implementing stringent air quality standards and targeted interventions for high-risk populations could mitigate the adverse health effects of NO2 pollution, and extend the lives of PLWHA.