The promotion of use of antiretroviral therapy (ART) prolongs the life expectancy of people living with HIV. But age-related diseases are increasingly common, and the risks of opportunistic infections, coinfections and poor health condition are also increased significantly in this group, resulting in high medical costs and heavy economic burden. However, there are few studies on the household economic burden of HIV/AIDS patients.

To investigate the household economic burden in HIV/AIDS patients and associated factors in four regions (Beijing, Henan, Guizhou and Anhui) of China.

From December 2020 to May 2021, by use of typical sampling, three medical institutions (one in Beijing, another in Guizhou and another in Anhui) , and a center for disease control and prevention (located in Henan) were selected, where HIV/AIDS patients who received health services in 2020 were chosen by convenient sampling. A questionnaire developed by our research team was used to collect information on the patients' sociodemographic and economic features, disease-related conditions, and treatment. Household economic burden was defined as ratio of out-of-pocket medical expenses to annual household income (OME/AHI) in 2020 exceeded 25%.

A total of 1 446 patients were included. The patients were classified into two major groups by the OME/AHI ratio: ≤1% group (n=400, 27.7%) , and >1%-5% group (n=418, 28.9%) . Two hundred and thirty-seven cases (16.4%) had household economic burden. The prevalence of household economic burden differed significantly by region, sex, age, marital status, education level, occupation, urban or rural hukou, floating or permanent population, type of medical insurance, annual household income level, route of infection, CD₄⁺ T cell count level, and type of medical treatment (P<0.001) . Stepwise multinomial Logistic regression analysis revealed the following: women had higher risk of household economic burden than men〔OR (95%CI) =1.729 (1.050, 2.853) 〕; Sixty-five-year-olds and above had higher risk of household economic burden than 18-24-year-olds〔OR (95%CI) =3.445 (1.188, 10.227) 〕; The divorced had higher risk of household economic burden than those unmarried〔OR (95%CI) =2.241 (1.073, 4.678) 〕; Public institution employees had lower risk of household economic burden than housekeepers, jobseekers, or those unemployed〔OR (95%CI) =0.287 (0.081, 0.898) 〕; Individuals with low〔OR (95%CI) =29.614 (12.348, 79.211) 〕 or low-to-middle annual household income〔OR (95%CI) =3.556 (1.471, 9.428) 〕 had higher risk of household economic burden compared with those with high annual household income; Heterosexual individuals had lower risk of household economic burden than homosexual individuals〔OR (95%CI) =0.356 (0.186, 0.670) 〕; ART non-recipients had lower risk of household economic burden than ART recipients〔OR (95%CI) =0.241 (0.055, 0.835) 〕; Individuals with CD₄⁺ T cell count 201-350 cells/μl〔OR (95%CI) =2.347 (1.237, 4.515) 〕 or ≤200 cells/μl〔OR (95%CI) =2.365 (1.200, 4.702) 〕 had higher risk of household economic burden compared with those with CD₄⁺ T cell count >500 cells/μl; Inpatient service recipients〔OR (95%CI) =12.492 (5.592, 27.818) 〕, and both outpatient and inpatient services recipients〔OR (95%CI) =23.69 (14.519, 39.933) 〕 had higher risk of household economic burden compared with outpatient service recipients.

HIV/AIDS patients had relatively low OME/AHI ratio generally, but some of them had household economic burden. Factors associated with household economic burden may include sociodemographic and economic factors such as sex, age, marital status, occupation, annual household income, and features related to HIV/AIDS and treatment such as route of infection, use of ART treatment, CD₄⁺ T cell count level, and type of medical treatment. To tangibly reduce the household economic burden of in this group, more attention should be paid to women, the elderly, those with very poor condition or low annual household income. Besides, it is essential to continue to implement and improve relevant medical insurance policies.