Disease burden of AIDS in last 30-year period and its predicted level in next 25-years based on the global burden disease 2019

Abstract

Background: This study examines global trends in acquired immune deficiency syndrome (AIDS) incidence, mortality, and disability-adjusted life years (DALYs) from 1990 to 2019, focusing on regional disparities in AIDS incidence, mortality, and DALYs across various levels of socio-demographic index (SDI). It also investigates variations in AIDS incidence, mortality, and DALYs across different age groups, and projects specific trends for the next 25 years.

Methods: Comprehensive data on AIDS from 1990 to 2019 in 204 countries and territories was obtained from a GBD study. This included information on AIDS incidence, mortality, DALYs, and age-standardized rates (ASRs). Projections for AIDS incidence and mortality over the next 25 years were generated using the Bayesian age-period-cohort model.

Results: From 1990 to 2019, the global incidence of HIV cases increased from 1,989,282 to 2,057,710, while the age-standardized incidence rate (ASIR) decreased from 37.59 to 25.24 with an estimated annual percentage change (EAPC) of -2.38. The ASIR exhibited an upward trend in high SDI and high-middle SDI regions, a stable trend in middle SDI regions, and a downward trend in low-middle SDI and low SDI regions. In regions with higher SDI, the ASIR was higher in males than in females, while the opposite was observed in lower SDI regions. Throughout 1990 to 2019, the age-standardized death rate (ASDR) and age-standardized DALY rate remained stable, with EAPCs of 0.24 and 0.08 respectively. Countries with the highest HIV burden affecting women and children under five years of age are primarily situated in lower SDI regions, particularly in sub-Saharan Africa. Projections indicate a significant continued decline in the age-standardized incidence and mortality rates of AIDS over the next 25 years, for both overall and by gender.

Conclusions: The global ASIR decreased from 1990 to 2019. Higher incidence and death rates were observed in the lower SDI region, indicating a greater susceptibility to AIDS among women and < 15 years old. This underscores the urgent need for increased resources to combat AIDS in this region, with focused attention on protecting women and < 15 years old as priority groups. The AIDS epidemic remained severe in sub-Saharan Africa. Projections for the next 25 years indicate a substantial and ongoing decline in both age-standardized incidence and mortality rates.

Keywords: Acquired immune deficiency syndrome; Death rate; Disability-adjusted life years; Global Burden Disease; Incidence rate; Social-demographic index.

Fig. 1

The incidence, death, and DALY rates of AIDS in different age groups globally. Note: A Incidence rate in 1990. B Incidence rate in 2019. C Death rate in 1990. D Death rate in 2019. E DALY rate in 1990. F DALY rate in 2019

Fig. 2

The change trends of age-standardized incidence, death, and DALY rate among different SDI quintiles. Note: A, B, C: Age-standardized incidence rate in both females and males, females, males. D, E, F: age-standardized death rate in both females and males, females, males. G, H, I: age-standardized DALY rate in both females and males, females, males

Fig. 3

The EAPC of AIDS in global and different regions. Note: A The EAPCs in ASIR. B The EAPCs in ASDR. C The EAPCs in age-standardized DALY rate

Fig. 4

The correlation between SDI and ASR, death, and DALY. Note: The circles represent the different 204 countries and territories that were available from GBD. The size of the circle indicates the number of people living with AIDS in that country and territories. The ρ is Pearson’s correlation coefficient and p values were derived from Pearson’s correlation analysis

Fig. 5

Distribution of different ages in AIDS incidence/death cases and DALYs. Note: A Incidence cases in 1990. B Incidence cases in 2019. C Death cases in 1990. D Death cases in 2019. E DALYs in 1990. F DALYs in 2019

Fig. 6

Correlation between feamle/male aged 15 to 29 years old and SDI. Note: The red dots represent the different countries and territories. The ρ is Pearson’s correlation coefficient and p values were derived from Pearson’s correlation analysis

Fig. 7

The global EAPC of AIDS for both females and males. Note: A The EAPC in ASIR. B The EAPC in ASDR. C The EAPC in age-standardized DALY rate

Fig. 8

The projections of global AIDS age-standardized incidence and mortality rates from 2020 to 2044 using Bayesian APC models. Note: Global age-standardized projections of HIV incidence (A, B, C) and mortality (D, E, F). Fan charts show the distribution of predictions between the 5% and 95% interquartiles, with shaded bands showing the prediction intervals in terms of. Predicted mean values are shown as solid lines. The vertical dashed line indicates where the prediction begins