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. 2015 Jul 6;10(7):e0131353.
doi: 10.1371/journal.pone.0131353. eCollection 2015.

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

Reuben Granich  1 , Somya Gupta  1 , Bradley Hersh  2 , Brian Williams  3 , Julio Montaner  4 , Benjamin Young  1 , José M Zuniga  1
Affiliations

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

Reuben Granich et al. PLoS One. .

Abstract

Background: Antiretroviral 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.

Methods: For 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.

Findings: In 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.

Interpretation: Over 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.

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Conflict of interest statement

Competing Interests: JM has also received limited unrestricted funding, paid to his institution, from Abbvie, Bristol-Myers Squibb, Gilead Sciences, Janssen, Merck, and ViiV Healthcare. Benjamin Young has received consulting/speaking fees from Bristol- Myers Squibb, Gilead Sciences, Merck & Co, ViiV Healthcare and research funding from Gilead Sciences and ViiV Healthcare. This does not alter the authors' adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Estimated annual AIDS-related deaths by country, 2013.
Number and percentage of estimated 1.5 million (1.4 million–1.7 million) global AIDS-related deaths in the eight highest burden countries for 2013.
Fig 2
Fig 2. Global AIDS-related death rate per 1000 people living with HIV in 2013.
Map of AIDS death rate per 1000 people living with HIV for 2013 for 30 high AIDS mortality burden countries and eight high-income countries. UNAIDS AIDS-related deaths estimates for 2013 are not available for countries shown in grey. Countries in white were not included in analyses.
Fig 3
Fig 3. Trends in estimated death rate per 1000 people living with HIV, 2001–2013.
Comparison of trends of estimated AIDS-related death rate per 1000 people living with HIV for selected high, middle and low-income countries from 2001 to 2013. Data from UNAIDS AIDSinfo data tool,18 the 2012 and 2013 UNAIDS Global Reports2 and Centers for Disease Control and Prevention Diagnoses of HIV Infection in the United States and Dependent Areas, 2011: HIV Surveillance Report, Volume 23.
Fig 4
Fig 4. Trends in estimated new infections, AIDS-related deaths and ART coverage in Nigeria and South Africa, 1990–2013.
Trends with uncertainty bounds for new infections (red), AIDS-related deaths (blue), and ART coverage percentage (green), 1990 to 2013. ART coverage is calculated as the percentage of people reported on ART among the estimated people living with HIV for the same time period.
Fig 5
Fig 5. Projected estimated deaths averted by ART coverage scenarios for South Africa and Nigeria, 1990–2020.
Projected deaths averted by ART expansion scenarios for South Africa and Nigeria. Reference baseline is projected deaths in the absence of ART (No ART scenario) which is compared to 1) maintenance of current ART coverage levels till 2020 (Current ART Coverage scenario); 2) expansion of access to 90% ART coverage rates of people eligible under WHO 2013 guidelines by 2020 (2013 WHO Guidelines scenario) and 3) UNAIDS “90-90-90” target or 81% of people living with HIV on ART by 2020 (90-90-90 Scenario). The estimated deaths averted represent the total difference from the No ART scenario.
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References

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