This study aimed to investigate the prevalence of HIV late presentation and advanced HIV disease and to identify the factors associated with HIV late presentation and advanced HIV disease among patients with newly diagnosed HIV/AIDS in the Guangxi Zhuang Autonomous Region, in Southwestern China. Patients with newly diagnosed HIV registered in the HIV surveillance system of Guangxi Centers for Disease Control between January 2012 and December 2016 were included in this study. Of 45,118 newly diagnosed patients, 70.2% had late presentation, and 45.1% had advanced HIV disease. A higher prevalence of late presentation and advanced HIV disease was found in male heterosexuals and female people who use drugs (PWID). Heterosexuals (OR 2.11 [95% CI 1.90–2.34]) and PWID (OR 1.55 [95% CI 1.30–1.84]) had a higher risk of late presentation than men who have sex with men (MSM). Blood testing of the blood receivers (OR 1.75 [95% CI 1.36–2.26]) and diagnosed in hospital (OR 1.74 [95% CI 1.65–1.84]) had an increased risk of late presentation compared to those who diagnosis in voluntary counseling and testing (VCT). Heterosexuals (OR 2.86 [95% CI 2.51–3.27]), PWID (OR 2.23 [95% CI 1.83–2.71]), blood testing of the blood receivers (OR 1.58 [95% CI 1.29–1.94]) and diagnosed in hospital (OR 1.85 [95% CI 1.76–1.94]) were also independent risk factors associated with advanced HIV disease. Older age, lower level of education and being divorced or widowed were also associated with late presentation and advanced HIV disease. Late presentation and advanced HIV disease were very common among patients with newly diagnosed HIV in Guangxi, China during 2012–2016. Targeted programs are urgently required to reduce HIV late diagnosis in Guangxi, especially for male heterosexuals, PWID, and patients with characteristics such as older age, lower level of education, divorced or widowed.

Objective: This study evaluates changes in HIV transmission and the effectiveness of interventions after two rounds of the Guangxi AIDS Conquering Project (GACP) in Guangxi, China. Methods: Samples and epidemiological data from newly diagnosed people with HIV (PWH) between 2014 and 2020 were analyzed. Molecular networks were constructed using nested PCR amplification and sequencing of the pol region, and multivariable logistic regression identified factors associated with clustering and high-degree nodes. Results: A total of 4227 valid sequences (73.12% inclusion rate) were analyzed. Demographic changes included an increasing proportion of individuals aged at least 50 years (49.66%), with lower education (50.51%), peasants (76.82%), and heterosexual transmission (90.29%). The overall clustering rate was 86.89%, with higher clustering among individuals aged at least 50 years (92.57%), those with primary school or below (89.09%), peasants (88.11%), and CRF08_BC infections (91.48%). Annual declines in cluster growth rate and clustering rates were observed, particularly among individuals aged less than 30 years, college graduates, MSM, and people who inject drugs (PWID). Key transmission hotspots were identified in Lingshan, particularly among older, less-educated individuals, and peasants. Factors associated with clustering included being male (aOR: 1.27), aged at least 50 years (aOR: 3.84), and infected with CRF08_BC (aOR: 2.12). From 2017 to 2020, the risk of clustering and high-degree nodes was lower compared to 2014–2016, suggesting the effectiveness of interventions. Conclusion: Interventions in Guangxi effectively reduced HIV transmission among younger, high-degree populations. However, older, less-educated individuals remain at high risk, necessitating targeted strategies to address their specific needs and achieve better HIV control.

Guangxi is one of the regions most affected by HIV-1 in China, yet the fine-scale transmission dynamics and molecular epidemiology remain incompletely characterized. In this study, we integrated molecular transmission network analysis, phylogenetic inference, and spatial analysis to elucidate HIV-1 dispersal patterns and inform precision public health interventions. We analyzed 10,199 HIV-1 pol sequences collected from all 14 cities in Guangxi, encompassing major subtypes including CRF01_AE, CRF07_BC, CRF08_BC, and CRF55_01B. Molecular networks were constructed using a 1.5% TN93 genetic-distance threshold, and logistic regression was applied to identify factors associated with network clustering. Bayesian phylogenetic and phylogeographic analyses were used to characterize spatiotemporal dissemination patterns. Overall, 75.6% (7,706/10,199) of individuals clustered within molecular networks, with clustering proportions exceeding 60% in every city. Factors independently associated with clustering included viral load >10,000 copies/mL (OR = 1.23, 95% CI: 1.10–1.39), education level of junior high school or below (OR = 1.67, 95% CI: 1.30–2.14), age ≥50 years (OR = 1.38, 95% CI: 1.16–1.63), Zhuang ethnicity (OR = 1.18, 95% CI: 1.08–1.30), and syringe sharing (OR = 1.65, 95% CI: 1.14–2.38). Intercity connections accounted for 48.2% of inferred genetic linkages, with CRF55_01B showing the highest intercity connectivity (60.4%). CRF01_AE displayed the broadest geographic distribution, Nanning and Qinzhou emerged as key connectivity hubs. Phylogeographic analyses suggested that Qinzhou was a major source of dispersal for CRF01_AE and CRF08_BC, whereas Nanning played a central role in the dissemination of CRF07_BC, CRF08_BC, and CRF55_01B. HIV-1 transmission in Guangxi is characterized by high network clustering and pronounced spatial heterogeneity, with distinct hub cities contributing to regional connectivity. These findings provide actionable evidence to support targeted, location-specific HIV prevention and control strategies at both local and regional levels.

Objective: Guangxi faces a persistent HIV epidemic driven by heterosexual transmission and aging populations. This study uses molecular network to examine network topology and dynamics over time, providing insights for HIV control strategies. Methods: A total of 9,751 samples were collected from HIV-infected individuals across Guangxi between 2005 and 2024. HIV pol gene was extracted, and molecular networks were constructed based on the TN93 genetic distance. Network indicators, including clustering rate, network density, degree distribution, transmission rate, and proportional detection rate, were calculated across four time periods (≤2009, 2010–2014, 2015–2020, 2021–2024). Stratified analyses were further conducted. Results: Population characteristics revealed pronounced epidemic aging (individuals aged ≥50 years increased from 10.6% to 62.3%) and a predominance of heterosexual transmission (rising from 50.4% to 90.6%). The network structure evolved from centralized to fragmented: clustering rate declined from 70.64% to 49.92%, network density decreased from 0.084 to 0.037, and the proportion of nodes with degree ≥4 fell from 37.50% to 13.34%. Degree distribution narrowed, suggesting a reduction in superspreading. Transmission rate and proportional detection rate also shifted downward, indicating suppressed network expansion in later periods. Stratified analyses showed higher clustering rates among heterosexual transmission, older adults, individuals with low education, and farmers, although overall declines were consistent across subgroups. Conclusions: This study highlights evolving HIV molecular network characteristics in Guangxi after three rounds of AIDS Conquering Project, offering evidence of reduced complexity and intensity over time. These findings inform planned HIV control efforts, underscoring the need for targeted interventions and enhanced monitoring, particularly for older, less-educated farmers.

The impact of low-level viremia (LLV) on virologic outcomes and drug resistance in Guangxi, a high-burden region of southwest China, remains poorly charact