Long-term Exposure to Ambient Particulate Matter is Associated with Prognosis in People Living with HIV/AIDS: Evidence from a Longitudinal Study.

Background: Evidence on the association between particulate matter (PM) exposure and prognosis in people living with HIV/AIDS (PWHA) is scarce. We aim to investigate the associations of long-term exposure to PM with AIDS -related deaths and complications. Methods: We collected follow-up information on 7444 PWHAs from 2000 to 2021 from the HIV/AIDS Comprehensive Response Information Management System of the Wuhan Center for Disease Control and Prevention. The AIDS -related deaths and complications were assessed by physicians every 3 to 6 months, and the monthly average PM concentrations for each PWHA were extracted from the China High Air Pollutants dataset. We employed time -varying Cox regression models to evaluate the associations of the average cumulative PM exposure concentrations with AIDS -related deaths and complications, as well as the mediating effects of AIDSrelated complications in PM -induced AIDS -related deaths. Results: For each 1 mu g/m 3 increase in PM 1 , PM 2.5 , and PM 10 , the adjusted hazard ratios (HRs) for AIDS -related deaths were 1.021 (1.009, 1.033), 1.012 (1.005, 1.020), and 1.010 (1.005, 1.015), respectively; and the HRs for AIDS -related complications were 1.049 (1.034, 1.064), 1.029 (1.020, 1.038), and 1.031 (1.024, 1.037), respectively. AIDS -related complications mediated 18.38 % and 18.68 % of the association of exposure to PM 1 and PM 2.5 with AIDS -related deaths, respectively. The association of PM exposure with AIDS -related deaths was more significant in older PWHA. Meanwhile, the association between PM exposure and AIDS -related complications was stronger in PWHA with a BMI >= 24 kg/m 2 . Conclusion: Long-term exposure to PM is positively associated with AIDS -related deaths and complications, and AIDS -related complications have mediating effects in PM -induced AIDS -related deaths. Our evidence emphasizes that enhanced protection against PM exposure for PWHAs is an additional mitigation strategy to reduce AIDSrelated deaths and complications.