Estimates of global, regional, and national incidence, prevalence, and mortality of HIV, 1980–2015: the Global Burden of Disease Study 2015

GBD 2015 HIV Collaborators, (2016) Estimates of global, regional, and national incidence, prevalence, and mortality of HIV, 1980–2015: the Global Burden of Disease Study 2015. Lancet, 3 (8). e361-e387.

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Abstract

Background: Timely assessment of the burden of HIV/AIDS is essential for policy setting and programme evaluation. In this report from the Global Burden of Disease Study 2015 (GBD 2015), we provide national estimates of levels and trends of HIV/AIDS incidence, prevalence, coverage of antiretroviral therapy (ART), and mortality for 195 countries and territories from 1980 to 2015.

Methods: For countries without high-quality vital registration data, we estimated prevalence and incidence with data from antenatal care clinics and population-based seroprevalence surveys, and with assumptions by age and sex on initial CD4 distribution at infection, CD4 progression rates (probability of progression from higher to lower CD4 cell-count category), on and off antiretroviral therapy (ART) mortality, and mortality from all other causes. Our estimation strategy links the GBD 2015 assessment of all-cause mortality and estimation of incidence and prevalence so that for each draw from the uncertainty distribution all assumptions used in each step are internally consistent. We estimated incidence, prevalence, and death with GBD versions of the Estimation and Projection Package (EPP) and Spectrum software originally developed by the Joint United Nations Programme on HIV/AIDS (UNAIDS). We used an open-source version of EPP and recoded Spectrum for speed, and used updated assumptions from systematic reviews of the literature and GBD demographic data. For countries with high-quality vital registration data, we developed the cohort incidence bias adjustment model to estimate HIV incidence and prevalence largely from the number of deaths caused by HIV recorded in cause-of-death statistics. We corrected these statistics for garbage coding and HIV misclassification.

Findings: Global HIV incidence reached its peak in 1997, at 3·3 million new infections (95% uncertainty interval [UI] 3·1–3·4 million). Annual incidence has stayed relatively constant at about 2·6 million per year (range 2·5–2·8 million) since 2005, after a period of fast decline between 1997 and 2005. The number of people living with HIV/AIDS has been steadily increasing and reached 38·8 million (95% UI 37·6–40·4 million) in 2015. At the same time, HIV/AIDS mortality has been declining at a steady pace, from a peak of 1·8 million deaths (95% UI 1·7–1·9 million) in 2005, to 1·2 million deaths (1·1–1·3 million) in 2015. We recorded substantial heterogeneity in the levels and trends of HIV/AIDS across countries. Although many countries have experienced decreases in HIV/AIDS mortality and in annual new infections, other countries have had slowdowns or increases in rates of change in annual new infections.

Interpretation: Scale-up of ART and prevention of mother-to-child transmission has been one of the great successes of global health in the past two decades. However, in the past decade, progress in reducing new infections has been slow, development assistance for health devoted to HIV has stagnated, and resources for health in low-income countries have grown slowly. Achievement of the new ambitious goals for HIV enshrined in Sustainable Development Goal 3 and the 90-90-90 UNAIDS targets will be challenging, and will need continued efforts from governments and international agencies in the next 15 years to end AIDS by 2030.

Item ID: 49414
Item Type: Article (Research - C1)
ISSN: 1474-547X
Additional Information:

Copyright © The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY license

GBD 2015 HIV Collaborators

Haidong Wang, Tim M Wolock, Austin Carter, Grant Nguyen, Hmwe Hmwe Kyu, Emmanuela Gakidou, Simon I Hay, Edward J Mills, Adam Trickey, William Msemburi, Matthew M Coates, Meghan D Mooney, Maya S Fraser, Amber Sligar, Joshua Salomon, Heidi J Larson, Joseph Friedman, Amanuel Alemu Abajobir, Kalkidan Hassen Abate, Kaja M Abbas, Mohamed Magdy Abd El Razek, Foad Abd-Allah, Abdishakur M Abdulle, Semaw Ferede Abera, Ibrahim Abubakar, Laith J Abu-Raddad, Niveen M E Abu-Rmeileh, Gebre Yitayih Abyu, Akindele Olupelumi Adebiyi, Isaac Akinkunmi Adedeji, Ademola Lukman Adelekan, Koranteng Adofo, Arsène Kouablan Adou, Oluremi N Ajala, Tomi F Akinyemiju, Nadia Akseer, Faris Hasan Al Lami, Ziyad Al-Aly, Khurshid Alam, Noore K M Alam, Deena Alasfoor, Saleh Fahed S Aldhahri, Robert William Aldridge, Miguel Angel Alegretti, Alicia V Aleman, Zewdie Aderaw Alemu, Rafael Alfonso-Cristancho, Raghib Ali, Ala'a Alkerwi, François Alla, Rajaa Mohammad Salem Al-Raddadi, Ubai Alsharif, Elena Alvarez, Nelson Alvis-Guzman, Azmeraw T Amare, Alemayehu Amberbir, Adeladza Kofi Amegah, Walid Ammar, Stephen Marc Amrock, Carl Abelardo T Antonio, Palwasha Anwari, Johan Ärnlöv, Al Artaman, Hamid Asayesh, Rana Jawad Asghar, Reza Assadi, Suleman Atique, Lydia S Atkins, Euripide Frinel G Arthur Avokpaho, Ashish Awasthi, Beatriz Paulina Ayala Quintanilla, Umar Bacha, Alaa Badawi, Aleksandra Barac, Till Bärnighausen, Arindam Basu, Tigist Assefa Bayou, Yibeltal Tebekaw Bayou, Shahrzad Bazargan-Hejazi, Justin Beardsley, Neeraj Bedi, Derrick A Bennett, Isabela M Bensenor, Balem Demtsu Betsu, Addisu Shunu Beyene, Eesh Bhatia, Zulfiqar A Bhutta, Sibhatu Biadgilign, Boris Bikbov, Sait Mentes Birlik, Donal Bisanzio, Michael Brainin, Alexandra Brazinova, Nicholas J K Breitborde, Alexandria Brown, Michael Burch, Zahid A Butt, Julio Cesar Campuzano, Rosario Cárdenas, Juan Jesus Carrero, Carlos A Castañeda-Orjuela, Jacqueline Castillo Rivas, Ferrán Catalá-López, Hsing-Yi Chang, Jung-chen Chang, Laxmikant Chavan, Wanqing Chen, Peggy Pei-Chia Chiang, Mirriam Chibalabala, Vesper Hichilombwe Chisumpa, Jee-Young Jasmine Choi, Devasahayam Jesudas Christopher, Liliana G Ciobanu, Cyrus Cooper, Tukur Dahiru, Solomon Abrha Damtew, Lalit Dandona, Rakhi Dandona, José das Neves, Pieter de Jager, Diego De Leo, Louisa Degenhardt, Robert P Dellavalle, Kebede Deribe, Amare Deribew, Don C Des Jarlais, Samath D Dharmaratne, Eric L Ding, Pratik Pinal Doshi, Kerrie E Doyle, Tim R Driscoll, Manisha Dubey, Yousef Mohamed Elshrek, Iqbal Elyazar, Aman Yesuf Endries, Sergey Petrovich Ermakov, Babak Eshrati, Alireza Esteghamati, Imad D A Faghmous, Carla Sofia e Sa Farinha, Andre Faro, Maryam S Farvid, Farshad Farzadfar, Seyed-Mohammad Fereshtehnejad, Joao C Fernandes, Florian Fischer, Joseph Robert Anderson Fitchett, Nataliya Foigt, Nancy Fullman, Thomas Fürst, Fortuné Gbètoho Gankpé, Teshome Gebre, Amanuel Tesfay Gebremedhin, Alemseged Aregay Gebru, Johanna M Geleijnse, Bradford D Gessner, Peter W Gething, Tsegaye Tewelde Ghiwot, Maurice Giroud, Melkamu Dedefo Gishu, Elizabeth Glaser, Shifalika Goenka, Amador Goodridge, Sameer Vali Gopalani, Atsushi Goto, Harish Chander Gugnani, Mark D C Guimaraes, Rahul Gupta, Rajeev Gupta, Vipin Gupta, Juanita Haagsma, Nima Hafezi-Nejad, Holly Hagan, Gessessew Bugssa Hailu, Randah Ribhi Hamadeh, Samer Hamidi, Mouhanad Hammami, Graeme J Hankey, Yuantao Hao, Hilda L Harb, Sivadasanpillai Harikrishnan, Josep Maria Haro, Kimani M Harun, Rasmus Havmoeller, Mohammad T Hedayati, Ileana Beatriz Heredia-Pi, Hans W Hoek, Masako Horino, Nobuyuki Horita, H Dean Hosgood, Damian G Hoy, Mohamed Hsairi, Guoqing Hu, Hsiang Huang, John J Huang, Kim Moesgaard Iburg, Bulat T Idrisov, Kaire Innos, Veena J Iyer, Kathryn H Jacobsen, Nader Jahanmehr, Mihajlo B Jakovljevic, Mehdi Javanbakht, Achala Upendra Jayatilleke, Panniyammakal Jeemon, Vivekanand Jha, Guohong Jiang, Ying Jiang, Tariku Jibat, Jost B Jonas, Zubair Kabir, Ritul Kamal, Haidong Kan, André Karch, Corine Kakizi Karema, Dimitris Karletsos, Amir Kasaeian, Anil Kaul, Norito Kawakami, Jeanne Françoise Kayibanda, Peter Njenga Keiyoro, Andrew Haddon Kemp, Andre Pascal Kengne, Chandrasekharan Nair Kesavachandran, Yousef Saleh Khader, Ibrahim Khalil, Abdur Rahman Khan, Ejaz Ahmad Khan, Young-Ho Khang, Jagdish Khubchandani, Yun Jin Kim, Yohannes Kinfu, Miia Kivipelto, Yoshihiro Kokubo, Soewarta Kosen, Parvaiz A Koul, Ai Koyanagi, Barthelemy Kuate Defo, Burcu Kucuk Bicer, Veena S Kulkarni, G Anil Kumar, Dharmesh Kumar Lal, Hilton Lam, Jennifer O Lam, Sinead M Langan, Van C Lansingh, Anders Larsson, James Leigh, Ricky Leung, Yongmei Li, Stephen S Lim, Steven E Lipshultz, Shiwei Liu, Belinda K Lloyd, Giancarlo Logroscino, Paulo A Lotufo, Raimundas Lunevicius, Hassan Magdy Abd El Razek, Mahdi Mahdavi, P A Mahesh, Marek Majdan, Azeem Majeed, Carla Makhlouf, Reza Malekzadeh, Chabila C Mapoma, Wagner Marcenes, Jose Martinez-Raga, Melvin Barrientos Marzan, Felix Masiye, Amanda J Mason-Jones, Bongani M Mayosi, Martin McKee, Peter A Meaney, Man Mohan Mehndiratta, Alemayehu B Mekonnen, Yohannes Adama Melaku, Peter Memiah, Ziad A Memish, Walter Mendoza, Atte Meretoja, Tuomo J Meretoja, Francis Apolinary Mhimbira, Ted R Miller, Joseph Mikesell, Mojde Mirarefin, Karzan Abdulmuhsin Mohammad, Shafiu Mohammed, Ali H Mokdad, Lorenzo Monasta, Maziar Moradi-Lakeh, Rintaro Mori, Ulrich O Mueller, Brighton Murimira, Gudlavalleti Venkata Satyanarayana Murthy, Aliya Naheed, Luigi Naldi, Vinay Nangia, Denis Nash, Haseeb Nawaz, Chakib Nejjari, Frida Namnyak Ngalesoni, Jean de Dieu Ngirabega, Quyen Le Nguyen, Muhammad Imran Nisar, Ole F Norheim, Rosana E Norman, Luke Nyakarahuka, Felix Akpojene Ogbo, In-Hwan Oh, Foluke Adetola Ojelabi, Bolajoko Olubukunola Olusanya, Jacob Olusegun Olusanya, John Nelson Opio, Eyal Oren, Erika Ota, Hye-Youn Park, Jae-Hyun Park, Snehal T Patil, Scott B Patten, Vinod K Paul, Katherine Pearson, Emmanuel Kwame Peprah, David M Pereira, Norberto Perico, Konrad Pesudovs, Max Petzold, Michael Robert Phillips, Julian David Pillay, Dietrich Plass, Suzanne Polinder, Farshad Pourmalek, David M Prokop, Mostafa Qorbani, Anwar Rafay, Kazem Rahimi, Vafa Rahimi-Movaghar, Mahfuzar Rahman, Mohammad Hifz Ur Rahman, Sajjad Ur Rahman, Rajesh Kumar Rai, Sasa Rajsic, Usha Ram, Saleem M Rana, Paturi Vishnupriya Rao, Giuseppe Remuzzi, David Rojas-Rueda, Luca Ronfani, Gholamreza Roshandel, Ambuj Roy, George Mugambage Ruhago, Mohammad Yahya Saeedi, Rajesh Sagar, Muhammad Muhammad Saleh, Juan R Sanabria, Itamar S Santos, Rodrigo Sarmiento-Suarez, Benn Sartorius, Monika Sawhney, Aletta E Schutte, David C Schwebel, Soraya Seedat, Sadaf G Sepanlou, Edson E Servan-Mori, Masood Ali Shaikh, Rajesh Sharma, Jun She, Sara Sheikhbahaei, Jiabin Shen, Kenji Shibuya, Hwashin Hyun Shin, Inga Dora Sigfusdottir, Naris Silpakit, Diego Augusto Santos Silva, Dayane Gabriele Alves Silveira, Edgar P Simard, Shireen Sindi, Jasvinder A Singh, Om Prakash Singh, Prashant Kumar Singh, Vegard Skirbekk, Karen Sliwa, Samir Soneji, Reed J D Sorensen, Joan B Soriano, David O Soti, Chandrashekhar T Sreeramareddy, Vasiliki Stathopoulou, Nicholas Steel, Bruno F Sunguya, Soumya Swaminathan, Bryan L Sykes, Rafael Tabarés-Seisdedos, Roberto Tchio Talongwa, Mohammad Tavakkoli, Bineyam Taye, Bemnet Amare Tedla, Tesfaye Tekle, Girma Temam Shifa, Awoke Misganaw Temesgen, Abdullah Sulieman Terkawi, Fisaha Haile Tesfay, Gizachew Assefa Tessema, Kiran Thapa, Alan J Thomson, Andrew L Thorne-Lyman, Ruoyan Tobe-Gai, Roman Topor-Madry, Jeffrey Allen Towbin, Bach Xuan Tran, Zacharie Tsala Dimbuene, Nikolaos Tsilimparis, Abera Kenay Tura, Kingsley Nnanna Ukwaja, Chigozie Jesse Uneke, Olalekan A Uthman, N Venketasubramanian, Sergey K Vladimirov, Vasiliy Victorovich Vlassov, Stein Emil Vollset, Linhong Wang, Elisabete Weiderpass, Robert G Weintraub, Andrea Werdecker, Ronny Westerman, Tissa Wijeratne, James D Wilkinson, Charles Shey Wiysonge, Charles D A Wolfe, Sungho Won, John Q Wong, Gelin Xu, Ajit Kumar Yadav, Bereket Yakob, Ayalnesh Zemene Yalew, Yuichiro Yano, Mehdi Yaseri, Henock Gebremedhin Yebyo, Paul Yip, Naohiro Yonemoto, Seok-Jun Yoon, Mustafa Z Younis, Chuanhua Yu, Shicheng Yu, Zoubida Zaidi, Maysaa El Sayed Zaki, Hajo Zeeb, Hao Zhang, Yong Zhao, Sanjay Zodpey, Leo Zoeckler, Liesl Joanna Zuhlke, Alan D Lopez, Christopher J L Murray

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