Estimates of global, regional, and national incidence, prevalence, and mortality of HIV, 1980-2015

the Global Burden of Disease Study 2015

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 & 31 others 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, Arsene 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, Mehdi Javanbakht, GBD 2015 HIV Collaborators

*Corresponding author for this work

Research output: Contribution to journalArticle

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

Original languageEnglish
Pages (from-to)E361-E387
Number of pages27
JournalThe Lancet
Volume3
Issue number8
DOIs
Publication statusPublished - Aug 2016

Keywords

  • PROJECTION PACKAGE
  • SYSTEMATIC ANALYSIS
  • UNAIDS ESTIMATION
  • MALE CIRCUMCISION
  • 188 COUNTRIES
  • INFECTION
  • PREVENTION
  • EPIDEMIC
  • MODEL
  • TRIAL

Cite this

Wang, H., Wolock, T. M., Carter, A., Nguyen, G., Kyu, H. H., Gakidou, E., ... 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. The Lancet, 3(8), E361-E387. https://doi.org/10.1016/S2352-3018(16)30087-X

Estimates of global, regional, and national incidence, prevalence, and mortality of HIV, 1980-2015 : the Global Burden of Disease Study 2015. / Wang, Haidong; Wolock, Tim M.; Carter, Austin; Nguyen, Grant; Kyu, Hmwe Hmwe; Gakidou, Emmanuela; Hay, Simon I.; Mills, Edward J.; Trickey, Adam; Msemburi, William; Coates, Matthew M.; Mooney, Meghan D.; Fraser, Maya S.; Sligar, Amber; Salomon, Joshua; Larson, Heidi J.; Friedman, Joseph; Abajobir, Amanuel Alemu; Abate, Kalkidan Hassen; Abbas, Kaja M.; Abd El Razek, Mohamed Magdy; Abd-Allah, Foad; Abdulle, Abdishakur M.; Abera, Semaw Ferede; Abubakar, Ibrahim; Abu-Raddad, Laith J.; Abu-Rmeileh, Niveen M. E.; Abyu, Gebre Yitayih; Adebiyi, Akindele Olupelumi; Adedeji, Isaac Akinkunmi; Adelekan, Ademola Lukman; Adofo, Koranteng; Adou, Arsene Kouablan; Ajala, Oluremi N.; Akinyemiju, Tomi F.; Akseer, Nadia; Al Lami, Faris Hasan; Al-Aly, Ziyad; Alam, Khurshid; Alam, Noore K. M.; Alasfoor, Deena; Aldhahri, Saleh Fahed S.; Aldridge, Robert William; Alegretti, Miguel Angel; Aleman, Alicia V.; Alemu, Zewdie Aderaw; Alfonso-Cristancho, Rafael; Ali, Raghib; Alkerwi, Ala'a; Javanbakht, Mehdi; GBD 2015 HIV Collaborators.

In: The Lancet, Vol. 3, No. 8, 08.2016, p. E361-E387.

Research output: Contribution to journalArticle

Wang, H, Wolock, TM, Carter, A, Nguyen, G, Kyu, HH, Gakidou, E, Hay, SI, Mills, EJ, Trickey, A, Msemburi, W, Coates, MM, Mooney, MD, Fraser, MS, Sligar, A, Salomon, J, Larson, HJ, Friedman, J, Abajobir, AA, Abate, KH, Abbas, KM, Abd El Razek, MM, Abd-Allah, F, Abdulle, AM, Abera, SF, Abubakar, I, Abu-Raddad, LJ, Abu-Rmeileh, NME, Abyu, GY, Adebiyi, AO, Adedeji, IA, Adelekan, AL, Adofo, K, Adou, AK, Ajala, ON, Akinyemiju, TF, Akseer, N, Al Lami, FH, Al-Aly, Z, Alam, K, Alam, NKM, Alasfoor, D, Aldhahri, SFS, Aldridge, RW, Alegretti, MA, Aleman, AV, Alemu, ZA, Alfonso-Cristancho, R, Ali, R, Alkerwi, A, Javanbakht, M & 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', The Lancet, vol. 3, no. 8, pp. E361-E387. https://doi.org/10.1016/S2352-3018(16)30087-X
Wang, Haidong ; Wolock, Tim M. ; Carter, Austin ; Nguyen, Grant ; Kyu, Hmwe Hmwe ; Gakidou, Emmanuela ; Hay, Simon I. ; Mills, Edward J. ; Trickey, Adam ; Msemburi, William ; Coates, Matthew M. ; Mooney, Meghan D. ; Fraser, Maya S. ; Sligar, Amber ; Salomon, Joshua ; Larson, Heidi J. ; Friedman, Joseph ; Abajobir, Amanuel Alemu ; Abate, Kalkidan Hassen ; Abbas, Kaja M. ; Abd El Razek, Mohamed Magdy ; Abd-Allah, Foad ; Abdulle, Abdishakur M. ; Abera, Semaw Ferede ; Abubakar, Ibrahim ; Abu-Raddad, Laith J. ; Abu-Rmeileh, Niveen M. E. ; Abyu, Gebre Yitayih ; Adebiyi, Akindele Olupelumi ; Adedeji, Isaac Akinkunmi ; Adelekan, Ademola Lukman ; Adofo, Koranteng ; Adou, Arsene Kouablan ; Ajala, Oluremi N. ; Akinyemiju, Tomi F. ; Akseer, Nadia ; Al Lami, Faris Hasan ; Al-Aly, Ziyad ; Alam, Khurshid ; Alam, Noore K. M. ; Alasfoor, Deena ; Aldhahri, Saleh Fahed S. ; Aldridge, Robert William ; Alegretti, Miguel Angel ; Aleman, Alicia V. ; Alemu, Zewdie Aderaw ; Alfonso-Cristancho, Rafael ; Ali, Raghib ; Alkerwi, Ala'a ; Javanbakht, Mehdi ; GBD 2015 HIV Collaborators. / Estimates of global, regional, and national incidence, prevalence, and mortality of HIV, 1980-2015 : the Global Burden of Disease Study 2015. In: The Lancet. 2016 ; Vol. 3, No. 8. pp. E361-E387.
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title = "Estimates of global, regional, and national incidence, prevalence, and mortality of HIV, 1980-2015: the Global Burden of Disease Study 2015",
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. Copyright (C) The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY license",
keywords = "PROJECTION PACKAGE, SYSTEMATIC ANALYSIS, UNAIDS ESTIMATION, MALE CIRCUMCISION, 188 COUNTRIES, INFECTION, PREVENTION, EPIDEMIC, MODEL, TRIAL",
author = "Haidong Wang and Wolock, {Tim M.} and Austin Carter and Grant Nguyen and Kyu, {Hmwe Hmwe} and Emmanuela Gakidou and Hay, {Simon I.} and Mills, {Edward J.} and Adam Trickey and William Msemburi and Coates, {Matthew M.} and Mooney, {Meghan D.} and Fraser, {Maya S.} and Amber Sligar and Joshua Salomon and Larson, {Heidi J.} and Joseph Friedman and Abajobir, {Amanuel Alemu} and Abate, {Kalkidan Hassen} and Abbas, {Kaja M.} and {Abd El Razek}, {Mohamed Magdy} and Foad Abd-Allah and Abdulle, {Abdishakur M.} and Abera, {Semaw Ferede} and Ibrahim Abubakar and Abu-Raddad, {Laith J.} and Abu-Rmeileh, {Niveen M. E.} and Abyu, {Gebre Yitayih} and Adebiyi, {Akindele Olupelumi} and Adedeji, {Isaac Akinkunmi} and Adelekan, {Ademola Lukman} and Koranteng Adofo and Adou, {Arsene Kouablan} and Ajala, {Oluremi N.} and Akinyemiju, {Tomi F.} and Nadia Akseer and {Al Lami}, {Faris Hasan} and Ziyad Al-Aly and Khurshid Alam and Alam, {Noore K. M.} and Deena Alasfoor and Aldhahri, {Saleh Fahed S.} and Aldridge, {Robert William} and Alegretti, {Miguel Angel} and Aleman, {Alicia V.} and Alemu, {Zewdie Aderaw} and Rafael Alfonso-Cristancho and Raghib Ali and Ala'a Alkerwi and Mehdi Javanbakht and {GBD 2015 HIV Collaborators}",
year = "2016",
month = "8",
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journal = "The Lancet",
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TY - JOUR

T1 - Estimates of global, regional, and national incidence, prevalence, and mortality of HIV, 1980-2015

T2 - the Global Burden of Disease Study 2015

AU - Wang, Haidong

AU - Wolock, Tim M.

AU - Carter, Austin

AU - Nguyen, Grant

AU - Kyu, Hmwe Hmwe

AU - Gakidou, Emmanuela

AU - Hay, Simon I.

AU - Mills, Edward J.

AU - Trickey, Adam

AU - Msemburi, William

AU - Coates, Matthew M.

AU - Mooney, Meghan D.

AU - Fraser, Maya S.

AU - Sligar, Amber

AU - Salomon, Joshua

AU - Larson, Heidi J.

AU - Friedman, Joseph

AU - Abajobir, Amanuel Alemu

AU - Abate, Kalkidan Hassen

AU - Abbas, Kaja M.

AU - Abd El Razek, Mohamed Magdy

AU - Abd-Allah, Foad

AU - Abdulle, Abdishakur M.

AU - Abera, Semaw Ferede

AU - Abubakar, Ibrahim

AU - Abu-Raddad, Laith J.

AU - Abu-Rmeileh, Niveen M. E.

AU - Abyu, Gebre Yitayih

AU - Adebiyi, Akindele Olupelumi

AU - Adedeji, Isaac Akinkunmi

AU - Adelekan, Ademola Lukman

AU - Adofo, Koranteng

AU - Adou, Arsene Kouablan

AU - Ajala, Oluremi N.

AU - Akinyemiju, Tomi F.

AU - Akseer, Nadia

AU - Al Lami, Faris Hasan

AU - Al-Aly, Ziyad

AU - Alam, Khurshid

AU - Alam, Noore K. M.

AU - Alasfoor, Deena

AU - Aldhahri, Saleh Fahed S.

AU - Aldridge, Robert William

AU - Alegretti, Miguel Angel

AU - Aleman, Alicia V.

AU - Alemu, Zewdie Aderaw

AU - Alfonso-Cristancho, Rafael

AU - Ali, Raghib

AU - Alkerwi, Ala'a

AU - Javanbakht, Mehdi

AU - GBD 2015 HIV Collaborators

PY - 2016/8

Y1 - 2016/8

N2 - 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. Copyright (C) The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY license

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

KW - PROJECTION PACKAGE

KW - SYSTEMATIC ANALYSIS

KW - UNAIDS ESTIMATION

KW - MALE CIRCUMCISION

KW - 188 COUNTRIES

KW - INFECTION

KW - PREVENTION

KW - EPIDEMIC

KW - MODEL

KW - TRIAL

U2 - 10.1016/S2352-3018(16)30087-X

DO - 10.1016/S2352-3018(16)30087-X

M3 - Article

VL - 3

SP - E361-E387

JO - The Lancet

JF - The Lancet

SN - 0140-6736

IS - 8

ER -