Global, regional, and national incidence, prevalence, and mortality of HIV, 1980–2017, and forecasts to 2030, for 195 countries and territories: a systematic analysis for the Global Burden of Diseases, Injuries, and Risk Factors Study 2017

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Abstract

BACKGROUND: Understanding the patterns of HIV/AIDS epidemics is crucial to tracking and monitoring the progress of prevention and control efforts in countries. We provide a comprehensive assessment of the levels and trends of HIV/AIDS incidence, prevalence, mortality, and coverage of antiretroviral therapy (ART) for 1980-2017 and forecast these estimates to 2030 for 195 countries and territories. METHODS: We determined a modelling strategy for each country on the basis of the availability and quality of data. For countries and territories with data from population-based seroprevalence surveys or antenatal care clinics, we estimated prevalence and incidence using an open-source version of the Estimation and Projection Package-a natural history model originally developed by the UNAIDS Reference Group on Estimates, Modelling, and Projections. For countries with cause-specific vital registration data, we corrected data for garbage coding (ie, deaths coded to an intermediate, immediate, or poorly defined cause) and HIV misclassification. We developed a process of cohort incidence bias adjustment to use information on survival and deaths recorded in vital registration to back-calculate HIV incidence. For countries without any representative data on HIV, we produced incidence estimates by pulling information from observed bias in the geographical region. We used a re-coded version of the Spectrum model (a cohort component model that uses rates of disease progression and HIV mortality on and off ART) to produce age-sex-specific incidence, prevalence, and mortality, and treatment coverage results for all countries, and forecast these measures to 2030 using Spectrum with inputs that were extended on the basis of past trends in treatment scale-up and new infections. FINDINGS: Global HIV mortality peaked in 2006 with 1·95 million deaths (95% uncertainty interval 1·87-2·04) and has since decreased to 0·95 million deaths (0·91-1·01) in 2017. New cases of HIV globally peaked in 1999 (3·16 million, 2·79-3·67) and since then have gradually decreased to 1·94 million (1·63-2·29) in 2017. These trends, along with ART scale-up, have globally resulted in increased prevalence, with 36·8 million (34·8-39·2) people living with HIV in 2017. Prevalence of HIV was highest in southern sub-Saharan Africa in 2017, and countries in the region had ART coverage ranging from 65·7% in Lesotho to 85·7% in eSwatini. Our forecasts showed that 54 countries will meet the UNAIDS target of 81% ART coverage by 2020 and 12 countries are on track to meet 90% ART coverage by 2030. Forecasted results estimate that few countries will meet the UNAIDS 2020 and 2030 mortality and incidence targets. INTERPRETATION: Despite progress in reducing HIV-related mortality over the past decade, slow decreases in incidence, combined with the current context of stagnated funding for related interventions, mean that many countries are not on track to reach the 2020 and 2030 global targets for reduction in incidence and mortality. With a growing population of people living with HIV, it will continue to be a major threat to public health for years to come. The pace of progress needs to be hastened by continuing to expand access to ART and increasing investments in proven HIV prevention initiatives that can be scaled up to have population-level impact. FUNDING: Bill & Melinda Gates Foundation, National Institute of Mental Health of the US National Institutes of Health (NIH), and the National Institute on Aging of the NIH.

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The record

Venue

The Lancet HIV

Topic

HIV/AIDS Research and Interventions

Field

Medicine

Canadian institutions

—

Funders

National Institute of Allergy and Infectious DiseasesMedical Research CouncilWeill Cornell Medicine - QatarSanofi PasteurSchool of Public Health and Family Medicine, University of Cape TownFood Innovation Center, Ohio State UniversityQatar National Research FundCenters for Disease Control and PreventionNational Institutes of HealthCochrane South AfricaSeqirusUniversity of Health and Allied SciencesUniversitair Ziekenhuis AntwerpenNIH Clinical CenterMoscow Institute of Physics and TechnologyWestern Sydney UniversityAmbo UniversityFrankfurt University of Applied SciencesI.M. Sechenov First Moscow State Medical UniversityKurdistan University Of Medical SciencesLorestan University of Medical SciencesAlborz University of Medical SciencesHawassa UniversityMansoura UniversityUniversity of Social Welfare and Rehabilitation SciencesWeill Cornell Medical CollegeXiamen UniversityResearch Institute for Endocrine Sciences, Shahid Beheshti University of Medical SciencesAlfaisal UniversityUniversity of GondarUniversidad del ValleArak University of Medical SciencesUniversity of Cape TownCentro de Investigación Biomédica en Red de Salud MentalQazvin University of Medical SciencesUniversity of TabrizBaki Dövlət UniversitetiInstitute for Research in Fundamental SciencesMinistério da Ciência, Tecnologia e Ensino SuperiorUniversity of California, IrvineUniversidade Federal de GoiásUniversity of the PhilippinesUniversidad Nacional Autónoma de MéxicoDebre Markos UniversityUniversität BielefeldBabol University of Medical SciencesUniversidade de São PauloUniversity of GhanaKermanshah University of Medical SciencesServierBirjand University of Medical SciencesUnited Arab Emirates UniversityEmory UniversityAhvaz Jundishapur University of Medical SciencesHaramaya UniversityUniversity College CorkTaipei Medical UniversityInyuvesi Yakwazulu-NataliBill and Melinda Gates FoundationUniversiteit GentTabriz University of Medical SciencesLeibniz-GemeinschaftUniversity of NamibiaMaragheh University of Medical SciencesSimon Fraser UniversityAin Shams UniversityShiraz University of Medical SciencesErasmus Universitair Medisch Centrum RotterdamSouth African Medical Research CouncilBundesministerium für GesundheitUniversidad Autónoma de SinaloaCardiff UniversityNational Research FoundationUniversity of CalcuttaBanaras Hindu UniversityMadda Walabu UniversityInstitució Catalana de Recerca i Estudis AvançatsNational Drug and Alcohol Research CentreSharif University of TechnologyYonsei UniversityUniversity of South CarolinaSeoul National UniversityNorth-West UniversityKing Saud UniversityNational Health and Medical Research CouncilMinistry of Education, Science and TechnologyBundesministerium für Bildung und ForschungSyddansk UniversitetHarvard UniversityJimma UniversityNational Institute on AgingFonds National de la Recherche LuxembourgFlinders UniversityUniversiteit UtrechtNational and Kapodistrian University of AthensCairo UniversityMonash UniversityPublic Health AgencyUniversity of PretoriaLunds UniversitetIlam University of Medical SciencesNational Institute of Child Health and Human DevelopmentJames Cook UniversityUniversity of TorontoShiraz UniversityKing's College LondonImperial College LondonNational Institute on Drug AbuseBirmingham City UniversityMuhimbili University of Health and Allied SciencesKasturba Medical College, ManipalMekelle UniversityUniversity of DhakaUniversiteit StellenboschWollega UniversityTrường Đại học Duy TânKerman University of Medical SciencesAddis Ababa UniversityDepartment of Science and Technology, Ministry of Science and Technology, IndiaNational Institute of Mental HealthInstitute for Health Metrics and EvaluationTehran University of Medical Sciences and Health ServicesFundação para a Ciência e a TecnologiaAksum UniversityBahir Dar UniversitySheffield Hallam UniversityAustralian GovernmentIndiviorIlam UniversitySaint Paul's Hospital Millennium Medical CollegeHealth CanadaLondon School of Economics and Political SciencePublic Health Agency of CanadaKaiser PermanenteMinistry of Health and Medical EducationMazandaran University of Medical SciencesGeorge Mason UniversityLoma Linda UniversityHuman Sciences Research CouncilYork UniversityPublic Health EnglandPublic Health Foundation of IndiaShahid Beheshti University of Medical SciencesAn-Najah National UniversityUniversity College LondonJohns Hopkins UniversityWellcome TrustQueensland HealthUniversidade Federal de Santa CatarinaUniversity of West FloridaCancer Research InstituteRafsanjan University of Medical SciencesHamadan University of Medical SciencesUniwersytet ŁódzkiHelsingin YliopistoUniversidade de LisboaOttawa Hospital Research InstituteSamara UniversityJordan University of Science and TechnologyUniversità degli Studi di SassariMcMaster UniversitySveučilište u ZagrebuSan Diego State UniversityMinistry of Health, Labour and WelfareAmarin CorporationCurtin University of TechnologyWuhan UniversityAteneo de Manila UniversityUniversity of WashingtonEuropean and Developing Countries Clinical Trials PartnershipDamietta UniversitySanofiTarbiat Modares UniversityUniversitas Negeri SemarangOhio State UniversityFogarty International CenterTrường Đại học Nguyễn Tất ThànhKarolinska InstitutetUnited Nations Population FundUniversity of WarwickEunice Kennedy Shriver National Institute of Child Health and Human DevelopmentNational Center of Neurology and PsychiatryAlexander von Humboldt-StiftungAmirkabir University of TechnologyApplied Molecular Biosciences UnitIran University of Medical SciencesJazan University

Keywords

MedicineIncidence (geometry)Human immunodeficiency virus (HIV)Environmental healthGlobal healthDeveloping countrySystematic reviewMEDLINEPublic healthEconomic growthVirologyPathology

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