Trends in AIDS Deaths, New Infections and ART Coverage in the Top 30 Countries with the Highest AIDS Mortality Burden; 1990–2013

Abstract

BackgroundAntiretroviral therapy (ART) prevents human immunodeficiency virus (HIV) disease progression, mortality and transmission. We assess the impact of expanded HIV treatment for the prevention of Acquired Immunodeficiency Syndrome (AIDS)-related deaths and simulate four treatment scenarios for Nigeria and South Africa.MethodsFor 1990–2013, we used the Joint United Nations Programme on HIV/AIDS (UNAIDS) database to examine trends in AIDS deaths, HIV incidence and prevalence, ART coverage, annual AIDS death rate, AIDS death-to-treatment and HIV infections to treatment ratios for the top 30 countries with the highest AIDS mortality burden and compare them with data from high-income countries. We projected the 1990–2020 AIDS deaths for Nigeria and South Africa using four treatment scenarios: 1) no ART; 2) maintaining current ART coverage; 3) 90% ART coverage based on 2013 World Health Organization (WHO) ART guidelines by 2020; and 4) reaching the United Nations 90-90-90 Target by 2020.FindingsIn 2013, there were 1.3 million (1.1 million–1.6 million) AIDS deaths in the top 30 countries representing 87% of global AIDS deaths. Eight countries accounted for 58% of the global AIDS deaths; Nigeria and South Africa accounted for 27% of global AIDS deaths. The highest death rates per 1000 people living with HIV were in Central African Republic (91), South Sudan (82), Côte d’Ivoire (75), Cameroon (72) and Chad (71), nearly 8–10 times higher than the high-income countries. ART access in 2013 has averted as estimated 1,051,354 and 422,448 deaths in South Africa and Nigeria, respectively. Increasing ART coverage in these two countries to meet the proposed UN 90-90-90 Target by 2020 could avert 2.2 and 1.2 million deaths, respectively.InterpretationOver the past decade the expansion of access to ART averted millions of deaths. Reaching the proposed UN 90-90-90 Target by 2020 will prevent additional morbidity, mortality and HIV transmission. Despite progress, high-burden countries will need to accelerate access to ART treatment to avert millions of premature AIDS deaths and new HIV infections.

Increased non‐AIDS mortality among persons with AIDS‐defining events after antiretroviral therapy initiation

“…In the era of antiretroviral therapy (ART), there have been striking decreases in acquired immune deficiency syndrome (AIDS)‐related mortality 1, 2, 3 and prolongation of life expectancy 4, 5, 6, 7 for people living with HIV infection (PLWH). With this, there has been a shift in distribution of causes of death toward non‐AIDS‐defining events (NADEs) 8, 9, 10, 11, 12.…”

Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013

“…Citation information for the data sources used for relative risks are provided in searchable form through a web tool. We estimate the joint eff ects of combinations of risk factors using the same methods as GBD 2013, namely using published studies to estimate the fraction of a risk that was mediated through the other risk (methods appendix pp [28][29][30][31][32][33][34][35]. Relative risks by age and sex for each risk factor and outcome pair are provided in the methods appendix (pp 215-44).…”

“…Gains in SDI are likely to operate through many pathways, including improved access to health care, public health programmes, and social and welfare policy. Advances in treatment are well documented for various causes, including HIV/AIDS, [30][31][32] ischaemic heart disease, [33][34][35][36][37] and various cancers, [38][39][40] including breast, [41][42][43] testicular, 44 and Hodgkin's, 45 yet for other causes, such as oesophageal cancer and interpersonal violence, the policies, programmes, and interventions responsible for declining risk-deleted death and DALY rates are less clear than for the aforementioned causes. Improvement of understanding of the risk-deleted rates in cause-specifi c mortality and disease burden will strengthen the evidence base for intervention eff ectiveness, the role of …”

“…High BMI is mediated through increases in systolic blood pressure, cholesterol, and fasting plasma glucose (methods appendix pp [28][29][30][31][32][33][34][35]. Our decomposition analysis suggests that the increase in risk-attributable burden due to high BMI is considerably smaller than it could have been if underlying rates, particularly for cardiovascular diseases, had not declined as much as they did over the past decade.…”

Modern biotechnology-based therapeutic approaches against HIV infection (Review)

“…Subsequently, it was found that the causative agent of AIDS was HIV. Currently, over 35 million individuals are HIV infected worldwide with the highest prevalence being in Sub-Saharan African countries (2,3). HIV type 1 is the most prevalent type of this virus (4).…”