Ending AIDS by 2030 a distant prospect, global HIV incidence, prevalence, treatment coverage and mortality figures suggest

Remarkable progress has been made towards curbing the global HIV epidemic, but there is little chance of achieving the UNAIDS goal of “ending AIDS” by 2030, according to data published in The Lancet. Investigators found that global HIV incidence peaked in 1997 and fell steadily until 2005. However, for the past ten years there have been only modest annual falls in the rate of new infections. Of the 195 countries included in the study, 102 experienced an increase in the annual number of new HIV infections between 2005 and 2015.  

No country has yet achieved the UNAIDS 90-90-90 target of having 90% of people with HIV diagnosed, 90% of diagnosed people on therapy and 90% of treated people virally suppressed. Globally only 41% of people living with HIV are receiving antiretroviral therapy (ART), and coverage of treatment remains low in many healthcare settings.

“This study shows that the AIDS epidemic is not over by any means and that HIV/AIDS remains one of the biggest public health threats in our time,” said Professor Peter Piot of the London School of Hygiene and Tropical Medicine. “The continuing high rate of over 2 million new HIV infections represents a collective failure which must be addressed through intensified prevention efforts and continued investment in HIV vaccine research.”

Glossary

90-90-90 target

A target set by the Joint United Nations Programme on HIV/AIDS (UNAIDS) for 90% of people with HIV to be diagnosed, 90% of diagnosed people to be taking treatment, and 90% of people on treatment to have an undetectable viral load. 

low income countries

The World Bank classifies countries according to their income: low, lower-middle, upper-middle and high. While the majority of the approximately 30 countries that are ranked as low income are in sub-Saharan Africa, many African countries including Kenya, Nigeria, South Africa and Zambia are in the middle-income brackets. 

generic

In relation to medicines, a drug manufactured and sold without a brand name, in situations where the original manufacturer’s patent has expired or is not enforced. Generic drugs contain the same active ingredients as branded drugs, and have comparable strength, safety, efficacy and quality.

antenatal

The period of time from conception up to birth.

virological suppression

Halting of the function or replication of a virus. In HIV, optimal viral suppression is measured as the reduction of viral load (HIV RNA) to undetectable levels and is the goal of antiretroviral therapy.

Since the mid 1990s, there have been concerted efforts to curb the global HIV epidemic. UNAIDS has set the 90-90-90 target for 2020, an essential step to achieving the end of AIDS by 2030. Surveillance data illustrating the global burden of HIV are needed to inform policy and programming and to determine if the 2020 and 2030 targets are achievable.

Investigators therefore analysed data collected via the Global Burden of Disease study between 1980 and 2015 to elucidate trends in HIV incidence, prevalence, treatment coverage and mortality.

Where possible, information was obtained from antenatal and population-based prevalence studies. Data from 195 countries covering all world regions were included.

Global HIV incidence peaked in 1997, at 3.3 million new infections, then decreased by 4.8% per year until 2005. Between 2005 and 2015, global incidence remained relatively stable with between 2.5 and 2.6 million new infections annually.

Prevalence of people with HIV increased rapidly, from 2.4 million in 1985 to 28 million in 2000. Thereafter, prevalence increased by 0.8% each year, reaching 38.8 million in 2015.

Sub-Saharan Africa continues to be badly hit by the epidemic, with 1.8 million new infections (75% of incident infections globally) in that region in 2015.

Russia had the highest HIV incidence in Europe and Cambodia the highest rate of new infections in Asia. Between 2005 and 2015, rates of new infections increased in numerous countries, including Egypt, Pakistan, Kenya, the Philippines, Cambodia, Mexico and Russia.

Mortality peaked at 1.8 million deaths in 2005, falling to 1.2 million in 2015. Tuberculosis continues to be a major cause of mortality in people with HIV, accounting for almost 20% of all deaths in 2005 and 18% of HIV-related mortality in 2015.

Access to ART remains limited in many settings, and globally only 41% of people were in receipt of therapy.

“Meeting the needs of people living with HIV will require a combination of concentrating development assistance for HIV on…low income countries, improving the efficiency of HIV programmes, increasing domestic financing, lowering the cost of treatment…and reducing future incidence through more concerted efforts,” comment the authors. “Development assistance efforts will also need to be scaled up if the free-flow of low-cost generic drugs is hampered.” Further collaboration between the public and private sectors is needed to devise effective prevention initiatives.

An estimated $36 billion funding annually is needed to achieve the 90-90-90 goal. The authors note that since 2010, donor funding for global AIDS projects has stagnated and is well short of this figure.

“Enormous progress has been made in reducing HIV deaths, especially in low income countries,” conclude the authors. “However, achievement of the UNAIDS 90-90-90 targets will require major changes in how programmes are delivered and financed. Global efforts have had less impact on incidence of new infections than on HIV mortality. Ending the AIDS epidemic by 2030 will require a dramatic change in how HIV prevention is pursued.”

References

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. The Lancet, 2015.