A thorough and precise comprehension understanding of the HIV epidemic is crucial for effective HIV prevention and control. We used Estimation and Projection Package (EPP)/Spectrum software to update the estimates of the overall HIV burden in China in 2018 from the obtained data from more than 1800 HIV sentinel surveillance sites, population-based seroprevalence surveys, and HIV screening of antenatal clinics and pre-marital medical check-ups across the country. In 2018, the total number of PLWH adults in China was estimated to be 1·23 million, corresponding to approximately 106.5/100,000. Over a half PLWH (58·6%) were infected through heterosexual contact, about one-third (30·2%) through male-to-male transmission, 9·0% through IDU, and 2·3% due to former plasma donation. In recent years, the number of new infections through blood donation has been eliminated, and the number of infections through injecting drug use has been kept low. Sexual contact became the predominant transmission route, while casual sexual contact became increasingly common. Overall, HIV mortality has been steadily increasing and has recently begun to decline during 2012-2018. The number of deaths from HIV/AIDS in 2018 was approximately 35 000 (95% UI: 30 000-41 000). The number of estimated PLWH in China has exceeded one million, due to the ongoing occurrence of new infections and longer survival rates. HIV transmission through blood products has been eradicated. Casual sex has become a significant mode of transmission. It is recommended to enhance the implementation of strategies and measures for sexual communication in the general population and to bolster multidisciplinary research.