This observational cohort was conducted in the rural areas of Guangxi, in southwest China. The cohort profile and characteristics of this database have been previously described [8, 10, 16]. The data were collected from 2003 to 2015. The eligibility criteria for the participants were 18 years or older, HIV-positive patients, recipient of first-line ART at any point between 2003 and 2015, willingness, and those who provide written consent for the study. It has 64% of participants still in follow-up. The study was approved by the institutional review board of the Guangxi Center for Disease Control and Prevention (reference number for the ethics committee to this manuscript is GXIRB2016-0047).

Attrition was defined as a cessation of ART or loss to follow-up as recorded in the HIV treatment database [18]. Lost to follow-up was defined as missing more than 90 days after the last date seen in the clinic, which was also defined as the date of withdrawal [10, 12].

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