Global HIV deaths declining, but incidence rates remain stagnant
Annual HIV mortality declined from 1.8 million to 1.2 million deaths since 2005, yet the worldwide rate of new infections has remained constant at approximately 2.6 million cases per year during the same period, according to findings from the Global Burden of Disease 2015 Study.
These data — recently released at AIDS 2016 in Durban, South Africa, and published in The Lancet HIV — also describes a steady increase in the number of people living with HIV and substantial trend disparities between individual countries.
“If this trend of stubbornly high new infections continues, there will be significant challenges in meeting the U.N.’s Sustainable Development Goal for the world to witness the end of AIDS in less than 15 years,” Christopher J.L. Murray, MD, DPhil, director of the Institute for Health Metrics and Evaluation (IHME) and professor of global health at the University of Washington, said in a press release. “Everyone in population health — researchers, policymakers, practitioners, pharmaceutical companies, advocates and others — needs to understand that even if more people are living with HIV, we cannot end AIDS without stopping new infections.”
To determine global HIV burden, Murray, Haidong Wang, PhD, assistant professor of global health at IHME and the University of Washington, and colleagues collected data from national registration systems, population surveys, antenatal care clinics and literature. Using epidemiological modeling software, they combined these with previously reported assessments of all-cause mortality and estimates of on- and off-ART mortality rates to determine annual HIV incidence, deaths and burden. The researchers compared these 2015 estimates to those of prior years to identify national and global trends.
According to the report, global HIV incidence peaked in 1997 with 3.3 million new infections yearly (95% uncertainty interval [UI], 3.1-3.4). This number declined to 2.6 million cases annually by 2005 (range 2.5-2.8 million), but has remained at this rate since. Further, the number of people living with HIV/AIDS increased to 38.8 million (95% UI, 37.6-40.4) in 2015, due to an annual HIV/AIDS mortality decline from 1.8 million deaths in 2005 (95% UI, 1.7-1.9) to 1.2 million deaths in 2015 (95% UI, 1.1-1.3).
ART use among those with HIV also increased from 2005 to 2015 in both men (6.4% to 38.6%) and women (3.3% to 42.4%), yet women were more likely than men to die at younger ages. Although death rates and incidence declined in most countries, including those with the greatest burden of HIV/AIDS, these two measures increased in several countries with historically lower prevalence, including the Philippines and Indonesia.
Overall, these estimates suggest “enormous progress” against HIV mortality in recent years, but less headway in reducing new cases, the researchers wrote.
“Development assistance for HIV/AIDS is stagnating and health resources in many low-income countries are expected to plateau over the next 15 years,” Murray said in another release. “Therefore, a massive scale-up of efforts from governments and international agencies will be required to meet the estimated $36 billion needed every year to realize the goal of ending AIDS by 2030, along with better detection and treatment programs and [improvements to] the affordability of antiretroviral drugs.”
Murray, Wang and colleagues’ estimates provide a clearer picture of the ongoing epidemic, Virginie Supervie, PhD, and Dominique Costagliola, PhD, biostatistics and epidemiology experts at the Pierre Louis Institute of Epidemiology and Public Health, Paris, wrote, but still leave some questions unanswered. In an accompanying editorial, they said that frequent revisions to the Global Burden of Disease estimates and those published by UNAIDS leave the true burden of HIV somewhat uncertain. Further, the prolonged period between HIV infection and death introduces a “time lag,” where current death rates may be more indicative of the prior decade’s incidence rates than the present.
“The [Global Burden of Disease] 2015 Study is far more than an update; it offers an opportunity to discuss several important issues about what remains to be done to track HIV epidemics,” Supervie and Costagliola wrote. “Without timely and reliable assessment of HIV incidence, achievement of the 90-90-90 UNAIDS target and ending of the HIV epidemic will be challenging. It is time to make the right investments.” – by Dave Muoio
Disclosures: Murray, Supervie and Wang report no relevant financial disclosures. Costagliola reports relationships with Gilead Sciences, InnaVirVax, Janssen-Cilag, and Merck-Sharp and Dohme-Chibret, and ViiV Healthcare. Please see the full study for a list of all other authors’ financial disclosures.