Spatial and Temporal Trends in HIV/AIDS Burden Among Worldwide Regions From 1990 to 2019: A Secondary Analysis of the Global Burden of Disease Study 2019

Abstract

Purpose: HIV/AIDS is a critical public health concern worldwide. This article investigated the spatial and temporal trends in HIV/AIDS burden from 1990 to 2019.

Methods: Data were extracted from the Global Burden of Disease (GBD) Study 2019. The estimated annual percentage change (EAPC) and the age-standardized rate (ASR) were used to quantify the change in trends at the global, regional, and national levels.

Results: In terms of temporal trends, during the period 1990-2004, increasing trends in prevalence (EAPC = 7.47, 95% confidence interval [CI] 5.84, 9.12), death (EAPC = 10.85, 95% CI 8.90-12.84), and disability-adjusted life years (DALYs) (EAPC = 10.40, 95% CI 8.47-12.36) of HIV/AIDS were observed. During the period 2005-2019, the global trends in HIV/AIDS incidence, death, and DALYs of HIV/AIDS decreased, with the EAPCs of -2.68 (95% CI-2.82--2.53), -6.73 (95% CI -6.98--6.47), and -6.75 (95% CI -6.95--6.54), respectively. However, the disease prevalence showed a slight increasing trend (EAPC = 0.71, 95% CI 0.54-0.87). In terms of spatial trends, over the past 15 years, trends in HIV/AIDS incidence of HIV/AIDS appeared upward in High-middle and High sociodemographic index (SDI) areas (EAPC = 6.51, 95% CI 5.50-7.53; EAPC = 2.31, 95% CI 2.02-2.60, respectively).

Conclusion: Decreasing trends in HIV/AIDS incidence, death, and DALYs have been observed worldwide over the past 15 years, especially in death and DALYs rates. However, the global population living with HIV/AIDS is still increasing. It is worth noting that an unfavorable trend emerged in High-middle and High SDI areas. Prevention and control of HIV/AIDS still need to be strengthened to counteract these concerning trends.

Keywords: acquired immune deficiency syndrome (AIDS); age-standardized rate (ASR); epidemiological trend; estimated annual percentage change (EAPC); global burden of disease (GBD); human immunodeficiency virus (HIV).

Figure 1

Trends in HIV/AIDS disease burden, including incidence, prevalence, death, and DALYs worldwide across SDI areas and geographic regions. (A) Distribution of the EAPCs of HIV/AIDS from 1990 to 2004; (B) Distribution of the EAPCs of HIV/AIDS from 2005 to 2019. EAPC, estimated annual percentage change.

Figure 2

The distribution of the EAPCs of HIV/AIDS burden at the national level during the period 1990–2004, including the incidence (A), prevalence (B), deaths (C), and DALYs (D). Countries/territories with extreme values are annotated. ASR, age-standardized rate; EAPC, estimated annual percentage change; DALYs, disability-adjusted life years.

Figure 3

The distribution of the EAPCs of HIV/AIDS burden at the national level during the period 2005–2019, including incidence (A), prevalence (B), death (C), and DALYs (D). Countries/territories with extreme values are annotated. ASR, age-standardized rate; EAPC, estimated annual percentage change; DALYs, disability-adjusted life years.

Figure 4

The association between EAPCs and ASR in 2005 at the national level during the period 2005–2019. The EAPCs of HIV/AIDS including the incidence (A), prevalence (B), death (C), and DALYs (D) had a negative association with the corresponding ASR in 2005. The associations were calculated using Pearson correlation analysis. The circles represent countries that had available HDI data, and the size of circles changes according to the number of HIV/AIDS cases in the corresponding countries in 2005. ASR, age-standardized rate; EAPC, estimated annual percentage change; DALYs, disability-adjusted life years.

Figure 5

The association between EAPCs and HDI in 2019 at the national level during the period 2005–2019. The EAPCs of HIV/AIDS including the incidence (A), prevalence (B), death (C), and DALYs (D) showed a positive association with the corresponding HDI in 2019. The associations were calculated using Pearson correlation analysis. The circles represent countries with available HDI data, and the size of the circles change according to the number of HIV/AIDS cases in the corresponding countries in 2019. EAPC, estimated annual percentage change; HDI, human development index.