HIV cases decline only by 17% between 2007 and 2017 as about 2 million people get infected every year
Although deaths from HIV/AIDS have been steadily declining from a peak in 2006, the number of new cases of HIV infections has gone down only by 17% during 2007-2017, from 2.35 million in 2007 to 1.94 million in 2017, shows a new analysis from the Global Burden of Disease (GBD) 2017.
Despite great advancements in antiretroviral therapy or ART (the use of medicines to treat HIV infections) and worldwide progress towards implementation of “treatment-as-prevention programs,” approximately two million people become newly infected with HIV every year.
The study, published in The Lancet HIV, says that the combination of decreased deaths and only a small decrease in incidence has led to an increase in the number of people living with HIV.
According to the research team, despite considerable progress made in reducing HIV-related deaths and increasing the coverage of ART, HIV/AIDS continues to have devastating health effects globally, with over 39 million HIV/AIDS-related deaths to date.
Further, over 36 million people still live with HIV/AIDS, which continues to be the underlying cause of death for almost 1 million people every year, concentrated in sub-Saharan Africa.
Recognizing the sustained threat, UNAIDS set targets for the years 2020 and 2030, with the aim of ending the epidemic by 2030.
Global deaths from HIV peaked in 2006, and have since decreased from 1.95 million deaths in 2006 to 0.95 million deaths in 2017.
New cases of HIV globally peaked in 1999 (3.16 million), and since then, have gradually decreased to 1.94 million in 2017.
“The scale-up of access to ART from 2.98 million people in 2006 to 21.8 million in 2017 was accompanied by a 51% reduction in HIV mortality, from 1.95 million in 2006 to 0.95 million in 2017. However, annual incidence or the number of new cases decreased by 17% during 2007-17, from 2.35 million in 2007 to 1.94 million in 2017. The combination of decreased mortality and only a small decrease in incidence has led to an increase in people living with HIV from 8.74 million in 1990 to 36.8 million in 2017,” says the study.
The GBD 2017 researchers examined trends in HIV incidence, prevalence, mortality, and treatment coverage for 195 countries and territories, from 1980 to 2017.
The findings are important as understanding the patterns of HIV/AIDS epidemics is crucial to tracking and monitoring the progress of prevention and control efforts in countries.
The researchers found that both in 2007 and 2017, younger adults (aged 25-49 years) comprised a high percentage of all HIV deaths compared with all other age groups.
Young adults also remain at the highest risk of acquiring HIV. Further, along with substantial variation in ART coverage, sub-Saharan Africa had the highest prevalence of HIV in 2017.
“Our estimates highlight differences in HIV burden between males and females. Females aged 30-34 years had the highest percentage of HIV deaths of all female age groups, 16.4% in 2007, and 14.9% in 2017. Whereas, males aged 35-39 years had the highest percentage of HIV deaths of all male age groups, 15·9% in 2007 and 14.8% in 2017,” the findings state.
The analysis further shows that new infections among women were mostly among younger adults, with 20.8% of new infections occurring among females aged 20-24 years in 2017, relatively unchanged from the incidence in 2007 (20.9%).
In 2017, males aged 25-29 years had the highest incidence of all male age groups, accounting for 18.6% of new infections that year, which is a substantial change from 2007, when the highest incidence in males occurred among those younger than one year.
“Despite men aged 25-29 years making up 4.2% and women aged 20-24 years making up 3.8% of the global population, they accounted for 9.3% and 10.3% of new infections in 2017. Among young adults, increased risk of HIV infection is associated with transactional sex, men who have sex with men, and injection drug use,” says the study.
The researchers state that although HIV infections in children have decreased substantially with the scale-up interventions for the prevention of mother-to-child transmission, in 2017, 139,555 new infections were in children younger than one year, and 122,254 HIV deaths were in children younger than 15 years.
“Most HIV deaths in people younger than 15 years are in children younger than five years, but this proportion has decreased from 82.1% in 2007 to 63.4% in 2017, showing the increase in lifespan for children who are HIV positive,” say the researchers.
The research team used the trends to forecast the course of country-specific HIV trends in the context of achieving UNAIDS goals.
They predict that as compared with ART coverage, fewer countries are expected to meet the UNAIDS 2020 or 2030 targets associated with deaths/mortality.
The authors project that treatment coverage will increase on a global scale from the current 59% to 64.8% by 2020 and 71.9% by 2030. Even though these anticipated improvements reflect progress, they fall short of the UNAIDS targets of 81% by 2020 and 90% by 2030, says the team.
The assessment shows that 54 countries are expected to meet the UNAIDS target of 81% ART coverage by 2020, and only 12 countries are on track to reach 90% ART coverage by 2030.
Most countries projected to achieve these goals are middle-income or high-income countries, where risks are relatively low. According to researchers, donor and domestic investments for HIV response in low-income countries have stagnated over the past five years.
“Of the 54 countries forecast to meet the 2020 ART coverage target, 25 are in the high-income super-region; 11 are in central Europe, eastern Europe, and central Asia; ten are in sub-Saharan Africa; six are in Latin America and the Caribbean; and two are in other regions (Mauritius and Kuwait),” the findings state.
The forecasts further show that fewer than ten countries will meet the mortality or incidence targets in 2020 and 2030.
“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 a population-level impact,” the researchers say.
The team recommends that to accelerate the decrease in HIV-related death, prevention, early detection, and treatment of “opportunistic infections” such as tuberculosis, should be a priority.
“Integration of services for HIV and tuberculosis, a leading cause of mortality among people living with HIV, is crucial as a strategy to increase linkage to HIV care and tackle the double burden of HIV and tuberculosis,” they add.